White Paper

The Impact of Formulary Controls on Commercially Insured Patients in Five Chronic Therapeutic Areas

The Impact of Formulary Controls on Commercially Insured Patients in Five Chronic Therapeutic Areas

Pages 12 Pages

An IQVIA white paper shows that formulary controls like prior authorization, step therapy, and exclusions create major barriers for commercially insured patients in chronic disease treatment. Across five therapeutic areas, 75–92% of patients were initially denied coverage, with over 90% denied in four areas. Even after appeals, 20–67% had no approval a year later. Patients who succeeded faced delays of three to five weeks, averaging two to four rejections, with some enduring 11+. Ultimately, 64–82% of those unable to overcome denials failed to start any treatment, highlighting how payer restrictions disrupt care and outcomes.

Join for free to read