PBM Formulary Exclusions In Oncology Are On The Rise

Physician-Administered Drugs Make Up Nearly Half Of Oncology Exclusions

Oncology drugs are no longer immune to pharmacy benefit management formulary exclusions in the commercial market and even drugs administered in a physician’s office are increasingly being subjected to rebate-driven coverage decisions.

Growing Competition Among Cancer Drugs Has Opened The Door To Exclusions • Source: Alamy

The leading US pharmacy benefit managers have significantly increased the number of oncology drugs subject to commercial formulary exclusions over the past five years and, notably, physician-administered drugs made up nearly half of the exclusions in the PBMs’ 2021 national drug lists, according to a new white paper from IQVIA.

“In a market like oncology where it has long been common belief that payers are unwilling to exert control, today...

Read the full article – start your free trial today!

Join thousands of industry professionals who rely on Scrip for daily insights

  • Start your 7-day free trial
  • Explore trusted news, analysis, and insights
  • Access comprehensive global coverage
  • Enjoy instant access – no credit card required

More from Drug Pricing

More from Scrip

AstraZeneca Taps Into China’s R&D Engine With CSPC Alliance

 

After in-licensing a cardiovascular candidate last year, AstraZeneca has signed a strategic drug discovery alliance, which could generate billions of dollars in payments to the Chinese firm.

Executives On The Move: New CMOs At Instil Bio, Nkarta & Catalyst Pharma

Recent moves in the industry include changes at the top at iOnctura and Orca Bio, plus Sutro Biopharma, Tenpoint Therapeutics and Helix BioPharma get new CFOs.

In Brief: Starton Moves Low-Dose Lenalidomide To Phase IIa For Multiple Myeloma

 

Study to add to safety and tolerability data for infused formulation and may help identify optimal dose for future pivotal trial.