METHODS: The coverage trends in five states (i.e., FL, IL, NY, TX and CA), covering ~116 million lives, were obtained from CMS. For each plan the data was obtained for the drug name, tier status, deductibles, and type of restrictions. The coverage trends were analyzed by drug name, state level and at a national level. A chi square test was conducted to test differences in percentage coverage for individual drugs. 

RESULTS: In the selected five states, 990 coverage policies were identified for the five approved oral breakthrough cancer drugs. Among them, 35%, 24%, 16%, 12% and 12% of the coverage policies are for Ibrance, Zydelig, Ofev, Imbruvica and Zykadia. The Tier coverage for these drugs varied from 4-6. Overall, 94% of the plans covered these drugs at Tier 5, and remaining 5% and 2% covered them at Tier 4 and Tier 6, respectively. 100% of these tier type were ‘specialty tier’. There were no statistically significant differences in Tier coverage among the five drugs. The co-insurance for the five drugs ranged from 25%-33%. For majority of the plans (58-68%) the coinsurance was 25%. Prior authorizations with quantity limits were imposed by 97% of the plans. The most common quantity limit was 21 pills for 28 days. The 30 day retail price for these drugs ranged from $8204 to $14590.

CONCLUSIONS: U.S. managed care access for new cancer drugs shows highly restricted market access, which is independent of individual drug’s indication or price. New policies might be needed to ensure proper access to these drugs for patients.