Evolution of the use of restrictions in commercial formularies

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By Gabriela Dieguez, Harsha Mirchandani | 03 November 2016

Prescription drug formularies include a variety of utilization and cost-controlling mechanisms. Specific drugs may be assigned to formulary tiers that require increased cost sharing; may be subject to step therapy requirements, prior authorization, and quantity limits; or may be excluded from the formulary altogether. This report uses drug formulary data covering over 150 million lives in the U.S. to examine the trends in the use of prior authorization, step therapy, formulary exclusion, and high tier placement in commercial formularies for the years 2011 to 2016.

This report was commissioned by Pfizer, Inc.