Hepatitis C medications are covered under the pharmacy benefit
with some limitations, most frequently prior authorizations and quantity
limits. For all of the drugs on the market, more than half of covered lives are
under the preferred tier/preferred with prior authorization or step therapy and
covered tier/covered with PA/ST. Payer pharmacy benefit formularies require
step therapy for 45% of the covered lives and prior authorization for 82% of
the lives. The graphics below show how hepatitis C medications are covered
among commercial health plans, health exchange programs and Medicare and
Medicaid programs, and their utilization management restrictions.
NOTE: The number of total covered lives is 302.1 million. The
numbers of total covered lives under commercial, health exchange and Medicare
formularies are 109.2 million, 10.6 million and 31.9 million, respectively.
SOURCE: Managed Markets Insight & Technology, LLC database as of December 2018.
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