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.

The number of drugs included on formulary exclusion lists in the US has surpassed more than 400 at the top three PBMs, representing dramatic growth from just five years ago. Express Scripts recently revealed its 2022 exclusions.

Novartis gets some praise for being willing to embrace cost-effective drug prices, but health policy analysts are skeptical the industry would truly adopt the idea for its best-selling drugs, particularly if the appropriate guardrails were put in place to ensure broader budget impact was controlled.  Holes were also poked in the way Novartis determined the total cost of drug utilization management on the US health system. 

Study will examine prior authorization and other access restrictions at 15 of the largest US commercial payers for a group of 27 drugs.