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PBM Formulary Exclusions In Oncology Are On The Rise

Physician-Administered Drugs Make Up Nearly Half Of Oncology Exclusions

 
• By Cathy Kelly

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...

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