- While plans were more likely to allow biosimilars for cancer patients, they were generally more likely to impose restrictions on biosimilar use for pediatric patients.
- Coverage decisions were also found to be influenced by market competition and budget impacts: the first biosimilars to enter the market were less likely to have restrictive coverage and biosimilars offering savings of $15,000 or more per patient annually were much less likely to be restricted. Furthermore, the availability of cost-effectiveness evidence correlated significantly with coverage being less constrained.
- Health plan pharmacy benefits managed by the three largest pharmacy benefit managers—CVS Caremark, dog hypothyroid dosage thyroxine Express Scripts, and OptumRx—were less likely to impose restrictions on biosimilar coverage relative to plans not managed by the big three.
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