October 2007 Fingertip Formulary Insights™
Key Findings
- Fill out those PA forms: Commercial plans had a significantly greater percentage of covered lives that required prior authorization than Medicare plans. Excluding the ED class, commercial plans had an average of 19% of covered lives covered with prior authorization compared to just 3% of covered lives for Medicare plans. On a relative basis, the prevalence of prior authorization was over six-fold higher for commercial plans. Significant differences were present for PPIs, Statins, ARBs, but not in the Osteoporosis class.
- Commercial heartburn: PPIs, in particular, had a wide disparity with significantly more commercial plan lives subjected to prior authorization as compared to Medicare lives. For the commercial market, 34% of covered lives require prior authorization as compared to just 8% of lives for Medicare plans.
Printable version (PDF 163KB)
Archives
December 2007: Lack of Impact from Two Key Generics in the Anti-depressant Formulary Market
October 2007: Formulary Position Differences between Commercial and Medicare Plans
September 2007: Impact of Patent Loss for Zocor on the Statin Marketplace
- Intro
- Formulary Access
- Trend Analysis
- Prior Authorization
- Quantity Limits
- Step Therapy
- Strategic Implications
Prior Authorization
