Current Market Access to ALS Medications

Featured Infographic   Current Market Access to ALS Medications   The FDA in May approved Radicava ORS (edaravone), an orally administered version of Mitsubishi Tanabe Pharma America’s Radicava, for the treatment of adults with amyotrophic lateral sclerosis (ALS). The six agents available to treat ALS are primarily covered under the pharmacy benefit, with medical benefit coverage available for only Radicava. For most ALS medications, more than half of commercial covered lives are under the preferred tier/preferred with prior authorization or step therapy and covered tier/covered with PA/ST.   Under the pharmacy benefit, about 42% of lives under commercial formularies have coverage for ALS drugs with utilization management restrictions. Meanwhile, almost 90% of lives under Medicare formularies lack coverage for at least one ALS therapy. For about 69% of covered lives, payer-controlled pharmacy benefit formularies require prior authorization.

NOTES: Under the pharmacy benefit, the total covered lives under commercial, health exchange, Medicare and Medicaid formularies are 166.8 million, 14.0 million, 49.5 million and 78.3 million, respectively.   SOURCE: Managed Markets Insight & Technology, LLC database as of Septemebr 2022.   From Radar on Drug Benefits Learn more about subscribing to AIS Health's publications.