Essential Health Benefits Prescription Drug Coverage

Transcription

1 Essential Health Benefits Prescription Drug Coverage ARKANSAS Arkansas EHB benchmark HMO Partners, Inc., Open Access POS covers 1.2% of available medicines, ranking it the 2th most generous in the country The Affordable Care Act (ACA) requires individual and small group health plans beginning in 214 to cover essential health benefits (EHB) a set of ten categories of healthcare services, i whose scope is defined by state-selected benchmark plans. ii Specific to medicines, health plans must cover at least the number of distinct chemical entities (without regard to brand or generic versions or different formulations) in each USP category and class as the state s EHB benchmark. iii These standards will not account for combination therapies, extended release medicines, therapies covered under the medical benefit, or newly approved medicines, leading to real access barriers for patients. First, combination therapies reduce pill burden and increase rates of compliance. Second, the lack of clarity on medical benefit therapies may result in less generous coverage for oral medicines than is typical in employer plans. Third, while plans have flexibility to add new medicines to their formulary mid-year, it is not required. Finally, these standards only apply to the number of medicines in a formulary not the cost-sharing or possible prior authorization or step-therapy requirements. EHB Drug Coverage Specifics in Arkansas The Arkansas EHB benchmark covers 1.2% of available medicines, ranking it the 2 th most generous benchmark. Though coverage in Arkansas is fairly broad, patients may still experience limits on their access to medicines as a result of cost-sharing or utilization management. Arkansas also has medication mandates that must be covered by EHB plans in the state: care management Coverage of off label use of medicines The state mandate for diabetes care management does not go beyond the protections that are a part of the EHB benchmark. Assurance of off label coverage can increase access if plans have strict coverage criteria. Analysis of Arkansas A recent analysis iv comparing the coverage of 8 classes of highly utilized medicines v by all state benchmarks showed that Arkansas benchmark offers high coverage compared to other states. Most High Utilization Classes Are Well Covered by the Arkansas EHB Asthma 8 8 Depression (Antidiabetics) 21 (Insulins) High Blood Pressure 8 High Cholesterol Seizures 4 Covered by AR Patients taking depression medications will likely have access to multiple brand products. The benchmark covers the maximum number of unique products in the seven remaining classes. In other words, patients taking medicines within these classes will likely have access to newer therapies.

2 An analysis comparing coverage of 8 classes of medicines for vulnerable populations vi showed that Arkansas s benchmark was at the high end of coverage for the classes analyzed. Vulnerable Populations Classes Have High Coverage in the Arkansas EHB Immune Suppressants 2 Cancer (Alkylating Agents) Cancer (Molucular Target Inhibitors) 12 HIV (Other Agents) HIV (Protease Inhibitors) Nausea Psychiatric Conditions Covered by AR The benchmark covers fewer products than the number of unique generics in the alkylating agents class. Cancer patients taking these medicines may not be able to access all newer therapies. At a minimum, plans must offer a limited number of brand options for molecular target inhibitors, immune suppressants, HIV (other agents), and nausea associated with chemotherapy. The benchmark covers the maximum number of unique products in three classes for psychotic conditions, cardiovascular disease, and protease inhibitors for HIV. Role for States in Ensuring Good Coverage EHB plans must offer coverage similar to employer plans and not discriminate against individuals because of their age, disability, degree of medical dependency, or expected length of life. States play a critical role in meeting these standards by reviewing plan formularies and providing oversight to ensure that plans do not discriminate. Even in classes of medicines where the benchmark requires broad coverage, plans may still be able to discriminate through cost-sharing requirements, utilization management or other means. Options for states to minimize the risk for discrimination include: Review tier placement, cost-sharing, and utilization management to ensure that EHB plan formularies reflect the standard of care. Incorporate other benefit reviews, such as distribution of each class of medicines across formulary tiers, to limit the potential for plans to discriminate against patients or to design benefit packages narrower than typical employer coverage. Oversee plan appeals process to ensure they are timely and fair. i The Affordable Care Act is the combination of the Patient Protection and Affordable Care Act (PPACA), P.L , enacted on March 2, 2, and the Health Care and Education Reconciliation Act of 2 (HCERA), P.L , enacted on March, 2. ii CMS offered states ten options from which to choose an EHB benchmark plan one of the three largest small group health plans in the state, one of the three largest state employee health plans in the state, one of the three largest federal health plans, and the state s largest HMO plan. iii If the benchmark covers no drugs in a given USP class, EHB plans must cover at least one drug in the class. iv Avalere Health analysis of Arkansas EHB, May 21. v The eight classes included in this analysis were, respectively: Antileukotrienes, Dyslipidemics (HMG COA Reductase Inhibitors), Serotonin/Norepinephrine Reuptake Inhibitors (SNRIs), Platelet Modifying Agents, Angiotensin II Receptor Antagonists, Antidiabetic Agents, Insulins, and Calcium Channel Modifying Agents. vi The eight classes included in this analysis were, respectively: Antipsychotics-2nd Generation/Atypical, Molecular Target Inhibitors, Anti-HIV Agents-Protease Inhibitors, Anticoagulants, Immune Suppressants, Alkylating Agents, Anti-HIV Agents-Other, and Emetogenic Therapy Adjuncts. Data and analysis by Avalere Health with funding from PhRMA.

3 Essential Health Benefits Prescription Drug Coverage CALIFORNIA California s EHB benchmark Kaiser Foundation Health Plan Small Group HMO covers 2.4% of available medicines, ranking it the 4th most generous in the country The Affordable Care Act (ACA) requires individual and small group health plans beginning in 214 to cover essential health benefits (EHB) a set of ten categories of healthcare services, i whose scope is defined by state-selected benchmark plans. ii Specific to medicines, health plans must cover at least the number of distinct chemical entities (without regard to brand or generic versions or different formulations) in each USP category and class as the state s EHB benchmark. iii These standards will not account for combination therapies, extended release medicines, therapies covered under the medical benefit, or newly approved medicines, leading to real access barriers for patients. First, combination therapies reduce pill burden and increase rates of compliance. Second, the lack of clarity on medical benefit therapies may result in less generous coverage for oral medicines than is typical in employer plans. Third, while plans have flexibility to add new medicines to their formulary mid-year, it is not required. Finally, these standards only apply to the number of medicines in a formulary not the cost-sharing or possible prior authorization or step-therapy requirements. EHB Drug Coverage Specifics in California The California EHB benchmark covers 2.4% of available medicines compared to the minimum of 4.% ranking it the 4 th most generous benchmark. Silver plans in California will have 2% coinsurance for medicines on the specialty tier, making it important that clinically appropriate medicines are available on a lower cost-sharing tier. California also has medication mandates that must be covered by EHB plans in the state: Coverage of off label use of medicines Pediatric asthma management therapies Pain management medication for the terminally ill Coverage of previously prescribed prescription medications The state mandates for pain and asthma management do not go beyond the protections that are part of the EHB benchmark. However, assurance of off label coverage can increase access if plans have strict coverage criteria. Additionally, the grandfathering of previously prescribed medicines will help patients as they transition between plans. Analysis of California s A recent analysis iv comparing the coverage of 8 classes of highly utilized medicines v by all state benchmarks showed that California s benchmark offers mid to low coverage compared to other states Most High Utilization Classes Are Minimally Covered by the California EHB Asthma 1 Depression (Antidiabetics) (Insulins) 1 High Blood Pressure High Cholesterol 4 Seizures 2 Covered by CA Patients taking medicines within of these classes may not have access to newer medicines, including asthma, depression, diabetes (antidiabetics), high blood pressure, high cholesterol, and seizures. Coverage may be better for cardiovascular disease and diabetes (insulins), where plans will not be able to limit coverage to generics.

4 An analysis comparing coverage of 8 classes of medicines for vulnerable populations vi showed that California s benchmark was at the high end of coverage for half of classes analyzed Vulnerable Populations Classes Have Mixed Coverage in the California EHB Immune Suppressants 1 Cancer (Alkylating Agents) Cancer (Molucular Target Inhibitors) 12 HIV (Other Agents) HIV (Protease Inhibitors) Nausea Psychiatric Conditions Covered by CA For cardiovascular disease, cancer (alkylating agents), and nausea, the benchmark covers fewer products than the number of unique generics in the classes. Patients taking such medicines may not be able to access any newer therapies. Four additional classes have moderate coverage. At a minimum, a limited number of brand products will be available for cancer (molecular target inhibitors), autoimmune disorders, psychotic conditions, and HIV (other agents). The benchmark covers the maximum number of drugs in one class. HIV patients will have access to all unique drugs in the HIV (protease inhibitors) class. Role for States in Ensuring Good Coverage EHB plans must offer coverage similar to employer plans and not discriminate against individuals because of their age, disability, degree of medical dependency, or expected length of life. States play a critical role in meeting these standards by reviewing plan formularies and providing oversight to ensure that plans do not discriminate. Options for states to minimize the risk for discrimination include: Review tier placement, cost-sharing, and utilization management to ensure that EHB plan formularies reflect the standard of care. Incorporate other benefit reviews, such as distribution of each class of medicines across formulary tiers, to limit the potential for plans to discriminate against patients or to design benefit packages narrower than typical employer coverage. Oversee plan appeals process to ensure they are timely and fair. i The Affordable Care Act is the combination of the Patient Protection and Affordable Care Act (PPACA), P.L , enacted on March 2, 2, and the Health Care and Education Reconciliation Act of 2 (HCERA), P.L , enacted on March, 2. ii CMS offered states ten options from which to choose an EHB benchmark plan one of the three largest small group health plans in the state, one of the three largest state employee health plans in the state, one of the three largest federal health plans, and the state s largest HMO plan. iii If the benchmark covers no drugs in a given USP class, EHB plans must cover at least one drug in the class. iv Avalere Health analysis of California s EHB, May 21. v The eight classes included in this analysis were, respectively: Antileukotrienes, Dyslipidemics (HMG COA Reductase Inhibitors), Serotonin/Norepinephrine Reuptake Inhibitors (SNRIs), Platelet Modifying Agents, Angiotensin II Receptor Antagonists, Antidiabetic Agents, Insulins, and Calcium Channel Modifying Agents. vi The eight classes included in this analysis were, respectively: Antipsychotics-2nd Generation/Atypical, Molecular Target Inhibitors, Anti-HIV Agents-Protease Inhibitors, Anticoagulants, Immune Suppressants, Alkylating Agents, Anti-HIV Agents-Other, and Emetogenic Therapy Adjuncts. Data and analysis by Avalere Health with funding from PhRMA.

5 Essential Health Benefits Prescription Drug Coverage COLORADO Colorado s EHB benchmark Kaiser Foundation Health Plan of Colorado HMO covers only 4.% of available medicines, ranking it the least generous in the country The Affordable Care Act (ACA) requires individual and small group health plans beginning in 214 to cover essential health benefits (EHB) a set of ten categories of healthcare services, i whose scope is defined by state-selected benchmark plans. ii Specific to medicines, health plans must cover at least the number of distinct chemical entities (without regard to brand or generic versions or different formulations) in each USP category and class as the state s EHB benchmark. iii These standards will not account for combination therapies, extended release medicines, therapies covered under the medical benefit, or newly approved medicines, leading to real access barriers for patients. First, combination therapies reduce pill burden and increase rates of compliance. Second, the lack of clarity on medical benefit therapies may result in less generous coverage for oral medicines than is typical in employer plans. Third, while plans have flexibility to add new medicines to their formulary mid-year, it is not required. Finally, these standards only apply to the number of medicines in a formulary not the cost-sharing or possible prior authorization or step-therapy requirements. EHB Drug Coverage Specifics in Colorado The Colorado EHB benchmark covers only 4.% of available medicines, ranking it the least generous benchmark plan in the nation. Colorado also has medication mandates that must be covered by EHB plans in the state: Oral anticancer medication care management Coverage of off label use of medicines The state mandates for oral anticancer and diabetes medications do not go beyond the protections that are a part of the EHB benchmark. However, assurance of off label coverage can increase access if plans have strict coverage criteria. Analysis of Colorado s A recent analysis iv comparing the coverage of 8 classes of highly utilized medicines v by all state benchmarks showed that Colorado s benchmark offers mid to low coverage compared to other states Most High Utilization Classes Are Minimally Covered by the Colorado EHB Asthma Depression (Antidiabetics) (Insulins) 1 High Blood Pressure High Cholesterol 4 Seizures Covered by CO Coverage of asthma medications by EHB plans may vary but will have at least one medicine in the class. Patients taking medicines within 4 of these classes may not have access to newer medicines, including depression, diabetes (antidiabetics), high blood pressure, and high cholesterol. Coverage may be slightly better for cardiovascular disease, diabetes (insulins), and seizures, where plans will not be able to limit coverage to generics.

6 An analysis comparing coverage of 8 classes of medicines for vulnerable populations vi showed that Colorado s benchmark was at the low end of coverage for half of the classes analyzed. Vulnerable Populations Classes Have Mostly Low Coverage in the Colorado EHB Immune Suppressants 14 Cancer (Alkylating Agents) Cancer (Molucular Target Inhibitors) 4 HIV (Other Agents) 2 HIV (Protease Inhibitors) Nausea Psychiatric Conditions Covered by CO For cardiovascular disease, cancer (alkylating agents), and nausea associated with chemotherapy, the benchmark covers fewer products than the number of unique generics in the classes. Patients taking such medicines may not be able to access any newer therapies. Four additional classes have moderate coverage. At a minimum, a limited number of brand products will be available for cancer (molecular target inhibitors), autoimmune disorders, psychotic conditions, and HIV (other agents). The benchmark covers the maximum number of drugs in one class. HIV patients will have access to all unique protease inhibitors. Role for States in Ensuring Good Coverage EHB plans must offer coverage similar to employer plans and not discriminate against individuals because of their age, disability, degree of medical dependency, or expected length of life. States play a critical role in meeting these standards by reviewing plan formularies and providing oversight to ensure that plans do not discriminate. Options for states to minimize the risk for discrimination include: Review tier placement, cost-sharing, and utilization management to ensure that EHB plan formularies reflect the standard of care. Incorporate other benefit reviews, such as distribution of each class of medicines across formulary tiers, to limit the potential for plans to discriminate against patients or to design benefit packages narrower than typical employer coverage. Oversee plan appeals process to ensure they are timely and fair. i The Affordable Care Act is the combination of the Patient Protection and Affordable Care Act (PPACA), P.L , enacted on March 2, 2, and the Health Care and Education Reconciliation Act of 2 (HCERA), P.L , enacted on March, 2. ii CMS offered states ten options from which to choose an EHB benchmark plan one of the three largest small group health plans in the state, one of the three largest state employee health plans in the state, one of the three largest federal health plans, and the state s largest HMO plan. iii If the benchmark covers no drugs in a given USP class, EHB plans must cover at least one drug in the class. iv Avalere Health analysis of Colorado s EHB, May 21. v The eight classes included in this analysis were, respectively: Antileukotrienes, Dyslipidemics (HMG COA Reductase Inhibitors), Serotonin/Norepinephrine Reuptake Inhibitors (SNRIs), Platelet Modifying Agents, Angiotensin II Receptor Antagonists, Antidiabetic Agents, Insulins, and Calcium Channel Modifying Agents. vi The eight classes included in this analysis were, respectively: Antipsychotics-2nd Generation/Atypical, Molecular Target Inhibitors, Anti-HIV Agents-Protease Inhibitors, Anticoagulants, Immune Suppressants, Alkylating Agents, Anti-HIV Agents-Other, and Emetogenic Therapy Adjuncts. Data and analysis by Avalere Health with funding from PhRMA.

7 Essential Health Benefits Prescription Drug Coverage DISTRICT OF COLUMBIA The District of Columbia s EHB benchmark BluePreferred PPO Option 1 covers only 1.2% of available medicines, ranking it the 4th most generous in the country The Affordable Care Act (ACA) requires individual and small group health plans beginning in 214 to cover essential health benefits (EHB) a set of ten categories of healthcare services, i whose scope is defined by state-selected benchmark plans. ii Specific to medicines, health plans must cover at least the number of distinct chemical entities (without regard to brand or generic versions or different formulations) in each USP category and class as the state s EHB benchmark. iii These standards will not account for combination therapies, extended release medicines, therapies covered under the medical benefit, or newly approved medicines, leading to real access barriers for patients. First, combination therapies reduce pill burden and increase rates of compliance. Second, the lack of clarity on medical benefit therapies may result in less generous coverage for oral medicines than is typical in employer plans. Third, while plans have flexibility to add new medicines to their formulary mid-year, it is not required. Finally, these standards only apply to the number of medicines in a formulary not the cost-sharing or possible prior authorization or step-therapy requirements. EHB Drug Coverage Specifics in DC The District of Columbia s EHB benchmark covers only 1.2% of available medicines compared to the minimum of 4.% ranking it the 4 th most generous benchmark. The District of Columbia also has medication mandates that must be covered by EHB plans in the state: care management Chemotherapy pill coverage The state mandates for diabetes care management and oral chemotherapy medications do not go beyond the protections that are a part of the EHB benchmark. Analysis of DC s A recent analysis iv comparing the coverage of 8 classes of highly utilized medicines v by all state benchmarks showed that the District of Columbia s benchmark offers low to moderate coverage compared to other states. Most High Utilization Classes Are Moderately Covered by the DC EHB Asthma 2 4 Depression (Antidiabetics) 1 (Insulins) High Blood Pressure High Cholesterol Seizures 2 Covered by DC Patients taking medicines within 4 classes may not have access to newer medicines, including asthma, cardiovascular disease, depression, and seizures. At a minimum, a limited number of brand products will be available for antidiabetics, insulin, high cholesterol, and high blood pressure.

8 An analysis comparing coverage of 8 classes of medicines for vulnerable populations vi showed that Colorado s benchmark was at the mid to high end of coverage for half of the classes analyzed. Vulnerable Populations Classes Have Moderate Coverage in the DC EHB Immune Suppressants Cancer (Alkylating Agents) Cancer (Molucular Target Inhibitors) 12 HIV (Other Agents) HIV (Protease Inhibitors) Nausea 4 Psychiatric Conditions Covered by DC For cancer (alkylating agents) and cardiovascular disease, the benchmark covers no more products than the number of unique generics in the classes. Patients taking these medicines may not be able to access any newer therapies. Five additional classes have moderate coverage. At a minimum, a limited number of brand products will be available for cancer (molecular target inhibitors), autoimmune disorders, psychotic conditions, HIV (other agents), and nausea associated with chemotherapy. The benchmark covers the maximum number of drugs in one class. HIV patients will have access to all unique protease inhibitors. Role for States in Ensuring Good Coverage EHB plans must offer coverage similar to employer plans and not discriminate against individuals because of their age, disability, degree of medical dependency, or expected length of life. States play a critical role in meeting these standards by reviewing plan formularies and providing oversight to ensure that plans do not discriminate. Options for states to minimize the risk for discrimination include: Review tier placement, cost-sharing, and utilization management to ensure that EHB plan formularies reflect the standard of care. Incorporate other benefit reviews, such as distribution of each class of medicines across formulary tiers, to limit the potential for plans to discriminate against patients or to design benefit packages narrower than typical employer coverage. Oversee plan appeals process to ensure they are timely and fair. i The Affordable Care Act is the combination of the Patient Protection and Affordable Care Act (PPACA), P.L , enacted on March 2, 2, and the Health Care and Education Reconciliation Act of 2 (HCERA), P.L , enacted on March, 2. ii CMS offered states ten options from which to choose an EHB benchmark plan one of the three largest small group health plans in the state, one of the three largest state employee health plans in the state, one of the three largest federal health plans, and the state s largest HMO plan. iii If the benchmark covers no drugs in a given USP class, EHB plans must cover at least one drug in the class. iv Avalere Health analysis of District of Columbia s EHB, May 21. v The eight classes included in this analysis were, respectively: Antileukotrienes, Dyslipidemics (HMG COA Reductase Inhibitors), Serotonin/Norepinephrine Reuptake Inhibitors (SNRIs), Platelet Modifying Agents, Angiotensin II Receptor Antagonists, Antidiabetic Agents, Insulins, and Calcium Channel Modifying Agents. vi The eight classes included in this analysis were, respectively: Antipsychotics-2nd Generation/Atypical, Molecular Target Inhibitors, Anti-HIV Agents-Protease Inhibitors, Anticoagulants, Immune Suppressants, Alkylating Agents, Anti-HIV Agents-Other, and Emetogenic Therapy Adjuncts. Data and analysis by Avalere Health with funding from PhRMA.

9 Essential Health Benefits Prescription Drug Coverage FLORIDA Florida s EHB benchmark BCBS Florida BlueOptions 42 PPO covers 8.% of available medicines, ranking it the th most generous in the country The Affordable Care Act (ACA) requires individual and small group health plans beginning in 214 to cover essential health benefits (EHB) a set of ten categories of healthcare services, i whose scope is defined by state-selected benchmark plans. ii Specific to medicines, health plans must cover at least the number of distinct chemical entities (without regard to brand or generic versions or different formulations) in each USP category and class as the state s EHB benchmark. iii These standards will not account for combination therapies, extended release medicines, therapies covered under the medical benefit, or newly approved medicines, leading to real access barriers for patients. First, combination therapies reduce pill burden and increase rates of compliance. Second, the lack of clarity on medical benefit therapies may result in less generous coverage for oral medicines than is typical in employer plans. Third, while plans have flexibility to add new medicines to their formulary mid-year, it is not required. Finally, these standards only apply to the number of medicines in a formulary not the cost-sharing or possible prior authorization or step-therapy requirements. EHB Drug Coverage Specifics in Florida The Florida EHB benchmark covers 8.% of available medicines, ranking it the th most generous benchmark. Florida also has medication mandates that must be covered by EHB plans in the state: care management Nutrition/formulas Coverage of off label use of medicines in cancer treatment Osteoporosis medications Temporomandibular joint disorder treatment, including medications The state mandates for diabetes, osteoporosis, and TMJ medications do not go beyond the protections that are a part of the EHB benchmark. Assurance of off label coverage for cancer treatments can increase access if plans have strict coverage criteria. Additionally, plans also must cover nutrition/formulas in Florida. Analysis of Florida s A recent analysis iv comparing the coverage of 8 classes of highly utilized medicines v by all state benchmarks showed that Florida s benchmark offers mid to high coverage compared to other states Most High Utilization Classes Are Well Covered by the Florida EHB Asthma Depression 21 (Antidiabetics) (Insulins) 8 High Blood Pressure High Cholesterol Seizures Covered by FL Insulin may be covered under the medical benefit in the benchmark plan, so coverage of insulin by EHB plans may vary but will have at least one medicine in the class. Patients taking medications for cardiovascular disease and seizures will likely have access to multiple brand products. The benchmark covers the maximum number of unique products in the remaining classes. In other words, patients taking medicines within these classes will likely have access to newer therapies.

10 An analysis comparing coverage of 8 classes of medicines for vulnerable populations vi showed that Florida s benchmark was at the mid to high end of coverage for the classes analyzed. Vulnerable Populations Classes Have Mixed Coverage in the Florida EHB Immune Suppressants 1 Cancer (Alkylating Agents) Cancer (Molucular Target Inhibitors) 12 HIV (Other Agents) HIV (Protease Inhibitors) Nausea Psychiatric Conditions Covered by FL The benchmark covers no more products than the number of unique generics in the alkylating agents class. In other words, patients may not be able to access any newer therapies in this class. At a minimum, a number of brand products will be available for immune suppressants, molecular target inhibitors, cardiovascular disease, nausea associated with chemotherapy, and other HIV agents. The benchmark covers the maximum number of unique products in the antipsychotics and protease inhibitors classes. Role for States in Ensuring Good Coverage EHB plans must offer coverage similar to employer plans and not discriminate against individuals because of their age, disability, degree of medical dependency, or expected length of life. States play a critical role in meeting these standards by reviewing plan formularies and providing oversight to ensure that plans do not discriminate. Even in classes of medicines where the benchmark requires broad coverage, plans may still be able to discriminate through cost-sharing requirements, utilization management or other means. Options for states to minimize the risk for discrimination include: Review tier placement, cost-sharing, and utilization management to ensure that EHB plan formularies reflect the standard of care. Incorporate other benefit reviews, such as distribution of each class of medicines across formulary tiers, to limit the potential for plans to discriminate against patients or to design benefit packages narrower than typical employer coverage. Oversee plan appeals process to ensure they are timely and fair. i The Affordable Care Act is the combination of the Patient Protection and Affordable Care Act (PPACA), P.L , enacted on March 2, 2, and the Health Care and Education Reconciliation Act of 2 (HCERA), P.L , enacted on March, 2. ii CMS offered states ten options from which to choose an EHB benchmark plan one of the three largest small group health plans in the state, one of the three largest state employee health plans in the state, one of the three largest federal health plans, and the state s largest HMO plan. iii If the benchmark covers no drugs in a given USP class, EHB plans must cover at least one drug in the class. iv Avalere Health analysis of Florida s EHB, May 21. v The eight classes included in this analysis were, respectively: Antileukotrienes, Dyslipidemics (HMG COA Reductase Inhibitors), Serotonin/Norepinephrine Reuptake Inhibitors (SNRIs), Platelet Modifying Agents, Angiotensin II Receptor Antagonists, Antidiabetic Agents, Insulins, and Calcium Channel Modifying Agents. vi The eight classes included in this analysis were, respectively: Antipsychotics-2nd Generation/Atypical, Molecular Target Inhibitors, Anti-HIV Agents-Protease Inhibitors, Anticoagulants, Immune Suppressants, Alkylating Agents, Anti-HIV Agents-Other, and Emetogenic Therapy Adjuncts. Data and analysis by Avalere Health with funding from PhRMA.

11 Essential Health Benefits Prescription Drug Coverage GEORGIA Georgia s EHB benchmark BCBS Healthcare Plan of Georgia, HMO Urgent Care covers 8.% of available medicines, ranking it the 1st most generous in the country The Affordable Care Act (ACA) requires individual and small group health plans beginning in 214 to cover essential health benefits (EHB) a set of ten categories of healthcare services, i whose scope is defined by state-selected benchmark plans. ii Specific to medicines, health plans must cover at least the number of distinct chemical entities (without regard to brand or generic versions or different formulations) in each USP category and class as the state s EHB benchmark. iii These standards will not account for combination therapies, extended release medicines, therapies covered under the medical benefit, or newly approved medicines, leading to real access barriers for patients. First, combination therapies reduce pill burden and increase rates of compliance. Second, the lack of clarity on medical benefit therapies may result in less generous coverage for oral medicines than is typical in employer plans. Third, while plans have flexibility to add new medicines to their formulary mid-year, it is not required. Finally, these standards only apply to the number of medicines in a formulary not the cost-sharing or possible prior authorization or step-therapy requirements. EHB Drug Coverage Specifics in Georgia The Georgia EHB benchmark covers 8.% of available medicines, ranking it the 1 st most generous benchmark. Though coverage in Georgia is fairly broad, patients may still experience limits on their access to medicines as a result of cost-sharing or utilization management. Georgia also has medication mandates that must be covered by EHB plans in the state: care management Asthma prescription medications Coverage of off label use of medicines The state mandates for diabetes and asthma medications do not go beyond the protections that are a part of the EHB benchmark. Assurance of off label coverage can increase access if plans have strict coverage criteria. Analysis of Georgia s A recent analysis iv comparing the coverage of 8 classes of highly utilized medicines v by all state benchmarks showed that Georgia s benchmark offers mid to high coverage compared to other states Most High Utilization Classes Are Well Covered by the Georgia EHB Asthma Depression 21 (Antidiabetics) (Insulins) 8 8 High Blood Pressure High Cholesterol Seizures 4 Covered by GA At a minimum, a limited number of brand products will be available for cardiovascular disease and diabetes (insulin). The benchmark covers the maximum number of unique products in the remaining six classes. In other words, patients taking medicines within these classes will likely have access to newer therapies.

12 An analysis comparing coverage of 8 classes of medicines for vulnerable populations vi showed that Georgia s benchmark was at the mid to high end of coverage for the classes analyzed. Vulnerable Populations Classes Have Mixed Coverage in the Georgia EHB Immune Suppressants 14 Cancer (Alkylating Agents) Cancer (Molucular Target Inhibitors) 11 HIV (Other Agents) HIV (Protease Inhibitors) Nausea Psychiatric Conditions Covered by GA The benchmark covers no more products than the number of unique generics in one class. Patients taking alkylating agents may not be able to access all newer therapies. At a minimum, plans must offer multiple brand-name options in the molecular target inhibitors, immune suppressants, HIV (other agents), cardiovascular disease, and nausea associated with chemotherapy classes. The benchmark covers the maximum number of unique products in the classes used for psychotic conditions and protease inhibitors for HIV patients. Role for States in Ensuring Good Coverage EHB plans must offer coverage similar to employer plans and not discriminate against individuals because of their age, disability, degree of medical dependency, or expected length of life. States play a critical role in meeting these standards by reviewing plan formularies and providing oversight to ensure that plans do not discriminate. Even in classes of medicines where the benchmark requires broad coverage, plans may still be able to discriminate through cost-sharing requirements, utilization management or other means. Options for states to minimize the risk for discrimination include: Review tier placement, cost-sharing, and utilization management to ensure that EHB plan formularies reflect the standard of care. Incorporate other benefit reviews, such as distribution of each class of medicines across formulary tiers, to limit the potential for plans to discriminate against patients or to design benefit packages narrower than typical employer coverage. Oversee plan appeals process to ensure they are timely and fair. i The Affordable Care Act is the combination of the Patient Protection and Affordable Care Act (PPACA), P.L , enacted on March 2, 2, and the Health Care and Education Reconciliation Act of 2 (HCERA), P.L , enacted on March, 2. ii CMS offered states ten options from which to choose an EHB benchmark plan one of the three largest small group health plans in the state, one of the three largest state employee health plans in the state, one of the three largest federal health plans, and the state s largest HMO plan. iii If the benchmark covers no drugs in a given USP class, EHB plans must cover at least one drug in the class. iv Avalere Health analysis of Georgia s EHB, May 21. v The eight classes included in this analysis were, respectively: Antileukotrienes, Dyslipidemics (HMG COA Reductase Inhibitors), Serotonin/Norepinephrine Reuptake Inhibitors (SNRIs), Platelet Modifying Agents, Angiotensin II Receptor Antagonists, Antidiabetic Agents, Insulins, and Calcium Channel Modifying Agents. vi The eight classes included in this analysis were, respectively: Antipsychotics-2nd Generation/Atypical, Molecular Target Inhibitors, Anti-HIV Agents-Protease Inhibitors, Anticoagulants, Immune Suppressants, Alkylating Agents, Anti-HIV Agents-Other, and Emetogenic Therapy Adjuncts. Data and analysis by Avalere Health with funding from PhRMA.

13 Essential Health Benefits Prescription Drug Coverage IOWA Iowa s EHB benchmark Wellmark Inc., Alliance Select covers only.% of available medicines, ranking it the 42nd most generous in the country The Affordable Care Act (ACA) requires individual and small group health plans beginning in 214 to cover essential health benefits (EHB) a set of ten categories of healthcare services, i whose scope is defined by state-selected benchmark plans. ii Specific to medicines, health plans must cover at least the number of distinct chemical entities (without regard to brand or generic versions or different formulations) in each USP category and class as the state s EHB benchmark. iii These standards will not account for combination therapies, extended release medicines, therapies covered under the medical benefit, or newly approved medicines, leading to real access barriers for patients. First, combination therapies reduce pill burden and increase rates of compliance. Second, the lack of clarity on medical benefit therapies may result in less generous coverage for oral medicines than is typical in employer plans. Third, while plans have flexibility to add new medicines to their formulary mid-year, it is not required. Finally, these standards only apply to the number of medicines in a formulary not the cost-sharing or possible prior authorization or step-therapy requirements. EHB Drug Coverage Specifics in Iowa The Iowa EHB benchmark covers.% of available medicines compared to the minimum of 4.% ranking it the 42 nd most generous benchmark. Iowa also has medication mandates that must be covered by EHB plans in the state: care management Oral cancer medication The state mandates for diabetes and oral cancer medications do not go beyond the protections that are a part of the EHB benchmark. Analysis of Iowa s A recent analysis iv comparing the coverage of 8 classes of highly utilized medicines v by all state benchmarks showed that Iowa s benchmark offers high coverage compared to other states. Most High Utilization Classes Are Maximally Covered by the Iowa EHB Asthma Depression (Antidiabetics) 21 (Insulins) High Blood Pressure 8 High Cholesterol Seizures 4 Covered by IA At a minimum, at least some brand products should be available for cardiovascular disease. The benchmark covers the maximum number of unique products in the remaining classes. In other words, patients taking medicines within these classes will likely have access to newer therapies.

14 An analysis comparing coverage of 8 classes of medicines for vulnerable populations vi showed that Iowa s benchmark was at the lower end of coverage for the classes analyzed. Vulnerable Populations Classes Have Minimal Coverage in the Iowa EHB Immune Suppressants Cancer (Alkylating Agents) Cancer (Molucular Target Inhibitors) 1 4 HIV (Other Agents) 2 HIV (Protease Inhibitors) Nausea Psychiatric Conditions Covered by IA For autoimmune disorders, cancer (alkylating agents), and cardiovascular disease, the benchmark covers fewer products than the number of unique generics. Patients taking such medicines may not be able to access any newer therapies. In three classes, a limited number of brand products will be available for nausea associated with chemotherapy, HIV (other agents), and molecular target inhibitors. The benchmark covers the maximum number of drugs in two classes. Patients have access to all protease inhibitors and antipsychotics. Role for States in Ensuring Good Coverage EHB plans must offer coverage similar to employer plans and not discriminate against individuals because of their age, disability, degree of medical dependency, or expected length of life. States play a critical role in meeting these standards by reviewing plan formularies and providing oversight to ensure that plans do not discriminate. Options for states to minimize the risk for discrimination include: Review tier placement, cost sharing, and utilization management to ensure that EHB plan formularies reflect the standard of care. Incorporate other benefit reviews, such as distribution of each class of medicines across formulary tiers, to limit the potential for plans to discriminate against patients or to design benefit packages narrower than typical employer coverage. Oversee plan appeals process to ensure they are timely and fair. i The Affordable Care Act is the combination of the Patient Protection and Affordable Care Act (PPACA), P.L , enacted on March 2, 2, and the Health Care and Education Reconciliation Act of 2 (HCERA), P.L , enacted on March, 2. ii CMS offered states ten options from which to choose an EHB benchmark plan one of the three largest small group health plans in the state, one of the three largest state employee health plans in the state, one of the three largest federal health plans, and the state s largest HMO plan. iii If the benchmark covers no drugs in a given USP class, EHB plans must cover at least one drug in the class. iv Avalere Health analysis of Iowa s EHB, May 21. v The eight classes included in this analysis were: Antileukotrienes, Dyslipidemics (HMG COA Reductase Inhibitors), Serotonin/Norepinephrine Reuptake Inhibitors (SNRIs), Platelet Modifying Agents, Angiotensin II Receptor Antagonists, Antidiabetic Agents, Insulins, and Calcium Channel Modifying Agents. vi The eight classes included in this analysis were: Antipsychotics-2nd Generation/Atypical, Molecular Target Inhibitors, Anti-HIV Agents-Protease Inhibitors, Anticoagulants, Immune Suppressants, Alkylating Agents, Anti-HIV Agents-Other, and Emetogenic Therapy Adjuncts. Data and analysis by Avalere Health with funding from PhRMA.

15 Essential Health Benefits Prescription Drug Coverage ILLINOIS Illinois s EHB benchmark BCBS Illinois BlueAdvantage Entrepreneur PPO covers 8.% of available medicines, ranking it the th most generous in the country The Affordable Care Act (ACA) requires individual and small group health plans beginning in 214 to cover essential health benefits (EHB) a set of ten categories of healthcare services, i whose scope is defined by state-selected benchmark plans. ii Specific to medicines, health plans must cover at least the number of distinct chemical entities (without regard to brand or generic versions or different formulations) in each USP category and class as the state s EHB benchmark. iii These standards will not account for combination therapies, extended release medicines, therapies covered under the medical benefit, or newly approved medicines, leading to real access barriers for patients. First, combination therapies reduce pill burden and increase rates of compliance. Second, the lack of clarity on medical benefit therapies may result in less generous coverage for oral medicines than is typical in employer plans. Third, while plans have flexibility to add new medicines to their formulary mid-year, it is not required. Finally, these standards only apply to the number of medicines in a formulary not the cost-sharing or possible prior authorization or step-therapy requirements. EHB Drug Coverage Specifics in Illinois The Illinois EHB benchmark covers 8.% of available medicines, ranking it the th most generous benchmark. Illinois also has medication mandates that must be covered by EHB plans in the state: care management Parity of cancer medications Pain medication for breast cancer patients Amino acid-based elemental formulas The state mandates for diabetes, amino acid-based elemental formulas, and pain management for breast cancer do not go beyond the protections that are a part of the EHB benchmark. Additionally, the requirement that cancer medications are covered at parity will help ensure that patients have equal access to both oral and injectable cancer therapies. Analysis of Illinois s A recent analysis iv comparing the coverage of 8 classes of highly utilized medicines v by all state benchmarks showed that Illinois s benchmark offers high coverage compared to other states. Most High Utilization Classes Are Well Covered by the Illinois EHB Asthma Depression 21 (Antidiabetics) (Insulins) 8 High Blood Pressure High Cholesterol Seizures 4 Covered by IL Patients will likely have access to some newer therapies in the cardiovascular disease class. The benchmark covers the maximum number of unique products in the remaining classes. In other words, patients taking medicines within these classes will likely have access to newer therapies.

16 An analysis comparing coverage of 8 classes of medicines for vulnerable populations vi showed that Illinois s benchmark was at the mid to high end of coverage for the classes analyzed. Vulnerable Populations Classes Have Mixed Coverage in the Illinois EHB Immune Suppressants 1 Cancer (Alkylating Agents) Cancer (Molucular Target Inhibitors) 12 HIV (Other Agents) HIV (Protease Inhibitors) Nausea Psychiatric Conditions Covered by IL The benchmark covers fewer products than the number of unique generics in alkylating agent cancer drugs. Patients may not be able to access any newer therapies in this class. At a minimum, plans must offer multiple brand-name options in the autoimmune disorders, molecular target inhibitors, nausea associated with chemotherapy, and other HIV agents classes. The benchmark covers the maximum number of unique products in three classes: antipsychotics, HIV protease inhibitors, and cardiovascular disease. Role for States in Ensuring Good Coverage EHB plans must offer coverage similar to employer plans and not discriminate against individuals because of their age, disability, degree of medical dependency, or expected length of life. States play a critical role in meeting these standards by reviewing plan formularies and providing oversight to ensure that plans do not discriminate. Even in classes of medicines where the benchmark requires broad coverage, plans may still be able to discriminate through cost-sharing requirements, utilization management or other means. Options for states to minimize the risk for discrimination include: Review tier placement, cost sharing, and utilization management to ensure that EHB plan formularies reflect the standard of care. Incorporate other benefit reviews, such as distribution of each class of medicines across formulary tiers, to limit the potential for plans to discriminate against patients or to design benefit packages narrower than typical employer coverage. Oversee plan appeals process to ensure they are timely and fair. i The Affordable Care Act is the combination of the Patient Protection and Affordable Care Act (PPACA), P.L , enacted on March 2, 2, and the Health Care and Education Reconciliation Act of 2 (HCERA), P.L , enacted on March, 2. ii CMS offered states ten options from which to choose an EHB benchmark plan one of the three largest small group health plans in the state, one of the three largest state employee health plans in the state, one of the three largest federal health plans, and the state s largest HMO plan. iii If the benchmark covers no drugs in a given USP class, EHB plans must cover at least one drug in the class. iv Avalere Health analysis of Illinois s EHB, May 21. v The eight classes included in this analysis were: Antileukotrienes, Dyslipidemics (HMG COA Reductase Inhibitors), Serotonin/Norepinephrine Reuptake Inhibitors (SNRIs), Platelet Modifying Agents, Angiotensin II Receptor Antagonists, Antidiabetic Agents, Insulins, and Calcium Channel Modifying Agents. vi The eight classes included in this analysis were: Antipsychotics-2nd Generation/Atypical, Molecular Target Inhibitors, Anti-HIV Agents-Protease Inhibitors, Anticoagulants, Immune Suppressants, Alkylating Agents, Anti-HIV Agents-Other, and Emetogenic Therapy Adjuncts. Data and analysis by Avalere Health with funding from PhRMA.

17 Essential Health Benefits Prescription Drug Coverage MARYLAND Maryland s EHB benchmark CareFirst BlueChoice HMO HSA Open Access covers only 1.2% of available medicines, ranking it the 4th most generous in the country The Affordable Care Act (ACA) requires individual and small group health plans beginning in 214 to cover essential health benefits (EHB) a set of ten categories of healthcare services, i whose scope is defined by state-selected benchmark plans. ii Specific to medicines, health plans must cover at least the number of distinct chemical entities (without regard to brand or generic versions or different formulations) in each USP category and class as the state s EHB benchmark. iii These standards will not account for combination therapies, extended release medicines, therapies covered under the medical benefit, or newly approved medicines, leading to real access barriers for patients. First, combination therapies reduce pill burden and increase rates of compliance. Second, the lack of clarity on medical benefit therapies may result in less generous coverage for oral medicines than is typical in employer plans. Third, while plans have flexibility to add new medicines to their formulary mid-year, it is not required. Finally, these standards only apply to the number of medicines in a formulary not the cost-sharing or possible prior authorization or step-therapy requirements. EHB Drug Coverage Specifics in Maryland The Maryland EHB benchmark covers only 1.2% of available medicines compared to the minimum of 4.% ranking it the 4 th most generous benchmark. Maryland also has specific medication mandates that must be covered by EHB plans in the state: care management Amino-acid based elemental formulas for infants Smoking cessation treatment The state mandates for diabetes and smoking cessation do not go beyond the protections that are a part of the EHB benchmark. Additionally, plans also must cover amino-based infant formulas in Maryland. Analysis of Maryland s A recent analysis iv comparing the coverage of 8 classes of highly utilized medicines v by all state benchmarks showed that Maryland s benchmark generally offers mid-level coverage compared to other states. Most High Utilization Classes Are Somewhat Covered by the Maryland EHB Asthma 2 4 Depression 1 (Antidiabetics) (Insulins) High Blood Pressure High Cholesterol Seizures 2 Covered by MD Patients taking medicines within these 4 classes may not have access to newer medicines, including asthma, cardiovascular disease, depression, and seizures. Coverage may be better for high blood pressure, high cholesterol, and diabetes (antidiabetics and insulins), where plans will not be able to limit coverage to generics.

18 An analysis comparing coverage of 8 classes of medicines for vulnerable populations vi showed that Maryland s benchmark was at the high end of coverage for only two of the classes analyzed. Vulnerable Populations Classes Have Mixed Coverage in the Maryland EHB Immune Suppressants Cancer (Alkylating Agents) Cancer (Molucular Target Inhibitors) 12 HIV (Other Agents) HIV (Protease Inhibitors) Nausea 4 Psychiatric Conditions Covered by MD For cancer (alkylating agents) and cardiovascular disease, the benchmark covers no more products than the number of unique generics in the classes. Patients taking such medicines may not be able to access any newer therapies. Five additional classes have moderate coverage. At a minimum, a limited number of brand products will be available for cancer (molecular target inhibitors), psychotic conditions, autoimmune disorders, nausea associated with cancer, and HIV (other agents). The benchmark covers the maximum number of drugs in one class. HIV patients will have access to all unique drugs in the HIV (protease inhibitors) class. Role for States in Ensuring Good Coverage EHB plans must offer coverage similar to employer plans and not discriminate against individuals because of their age, disability, degree of medical dependency, or expected length of life. States play a critical role in meeting these standards by reviewing plan formularies and providing oversight to ensure that plans do not discriminate. Options for states to minimize the risk for discrimination include: Review tier placement, cost sharing, and utilization management to ensure that EHB plan formularies reflect the standard of care. Incorporate other benefit reviews, such as distribution of each class of medicines across formulary tiers, to limit the potential for plans to discriminate against patients or to design benefit packages narrower than typical employer coverage. Oversee plan appeals process to ensure they are timely and fair. i The Affordable Care Act is the combination of the Patient Protection and Affordable Care Act (PPACA), P.L , enacted on March 2, 2, and the Health Care and Education Reconciliation Act of 2 (HCERA), P.L , enacted on March, 2. ii CMS offered states ten options from which to choose an EHB benchmark plan one of the three largest small group health plans in the state, one of the three largest state employee health plans in the state, one of the three largest federal health plans, and the state s largest HMO plan. iii If the benchmark covers no drugs in a given USP class, EHB plans must cover at least one drug in the class. iv Avalere Health analysis of Maryland s EHB, May 21. v The eight classes included in this analysis were: Antileukotrienes, Dyslipidemics (HMG COA Reductase Inhibitors), Serotonin/Norepinephrine Reuptake Inhibitors (SNRIs), Platelet Modifying Agents, Angiotensin II Receptor Antagonists, Antidiabetic Agents, Insulins, and Calcium Channel Modifying Agents. vi The eight classes included in this analysis were: Antipsychotics-2nd Generation/Atypical, Molecular Target Inhibitors, Anti-HIV Agents-Protease Inhibitors, Anticoagulants, Immune Suppressants, Alkylating Agents, Anti-HIV Agents-Other, and Emetogenic Therapy Adjuncts. Data and analysis by Avalere Health with funding from PhRMA.

19 Essential Health Benefits Prescription Drug Coverage MICHIGAN Michigan s EHB benchmark Priority Health s PriorityHMO covers only 8.% of available medicines, ranking it the 41st most generous in the country The Affordable Care Act (ACA) requires individual and small group health plans beginning in 214 to cover essential health benefits (EHB) a set of ten categories of healthcare services, i whose scope is defined by state-selected benchmark plans. ii Specific to medicines, health plans must cover at least the number of distinct chemical entities (without regard to brand or generic versions or different formulations) in each USP category and class as the state s EHB benchmark. iii These standards will not account for combination therapies, extended release medicines, therapies covered under the medical benefit, or newly approved medicines, leading to real access barriers for patients. First, combination therapies reduce pill burden and increase rates of compliance. Second, the lack of clarity on medical benefit therapies may result in less generous coverage for oral medicines than is typical in employer plans. Third, while plans have flexibility to add new medicines to their formulary mid-ear, it is not required. Finally, these standards only apply to the number of medicines in a formulary not the cost-sharing or possible prior authorization or step-therapy requirements. EHB Drug Coverage Specifics in Michigan The Michigan EHB benchmark covers only 8.% of available medicines compared to the minimum of 4.% ranking it the 41 st most generous benchmark. Michigan also has medication mandates that must be covered by EHB plans in the state: Antineoplastic therapies The state mandate for cancer medications does not go beyond the protections that are a part of the EHB benchmark. Analysis of Michigan s A recent analysis iv comparing the coverage of 8 classes of highly utilized medicines v by all state benchmarks showed that Michigan s benchmark offers generous coverage relative to other states. Most High Utilization Classes Are Maximally Covered by the Michigan EHB Asthma Depression (Antidiabetics) 21 (Insulins) High Blood Pressure 8 High Cholesterol Seizures Covered by MI Patients taking cardiovascular disease and seizure medications in these classes will likely have access to multiple brand products. The benchmark covers the maximum number of unique products in the remaining classes. In other words, patients taking medicines within these classes will likely have access to newer therapies.

20 An analysis comparing coverage of 8 classes of medicines for vulnerable populations vi showed that Michigan s benchmark was at the high end of coverage for half of classes analyzed. Vulnerable Populations Classes Have Mixed Coverage in the Michigan EHB Immune Suppressants 1 Cancer (Alkylating Agents) 2 Cancer (Molucular Target Inhibitors) 12 HIV (Other Agents) HIV (Protease Inhibitors) 8 Nausea Psychiatric Conditions Covered by MI For alkylating agents, the benchmark covers fewer products than the number of unique generics in the classes. Patients taking such medicines may not be able to access any newer therapies. At a minimum, plans must offer a limited number of brand options for molecular target inhibitors, autoimmune disorders, nausea associated with chemotherapy, protease inhibitors, and other HIV agents. The benchmark covers the maximum number of drugs in the remaining 2 classes. Patients will have access to all unique products in these cardiovascular and antipsychotics classes. Role for States in Ensuring Good Coverage EHB plans must offer coverage similar to employer plans and not discriminate against individuals because of their age, disability, degree of medical dependency, or expected length of life. States play a critical role in meeting these standards by reviewing plan formularies and providing oversight to ensure that plans do not discriminate. Options for states to minimize the risk for discrimination include: Review tier placement, cost sharing, and utilization management to ensure that EHB plan formularies reflect the standard of care. Incorporate other benefit reviews, such as distribution of each class of medicines across formulary tiers, to limit the potential for plans to discriminate against patients or to design benefit packages narrower than typical employer coverage. Oversee plan appeals process to ensure they are timely and fair. i The Affordable Care Act is the combination of the Patient Protection and Affordable Care Act (PPACA), P.L , enacted on March 2, 2, and the Health Care and Education Reconciliation Act of 2 (HCERA), P.L , enacted on March, 2. ii CMS offered states ten options from which to choose an EHB benchmark plan one of the three largest small group health plans in the state, one of the three largest state employee health plans in the state, one of the three largest federal health plans, and the state s largest HMO plan. iii If the benchmark covers no drugs in a given USP class, EHB plans must cover at least one drug in the class. iv Avalere Health analysis of Michigan s EHB, May 21. v The eight classes included in this analysis were: Antileukotrienes, Dyslipidemics (HMG COA Reductase Inhibitors), Serotonin/Norepinephrine Reuptake Inhibitors (SNRIs), Platelet Modifying Agents, Angiotensin II Receptor Antagonists, Antidiabetic Agents, Insulins, and Calcium Channel Modifying Agents. vi The eight classes included in this analysis were: Antipsychotics-2nd Generation/Atypical, Molecular Target Inhibitors, Anti-HIV Agents-Protease Inhibitors, Anticoagulants, Immune Suppressants, Alkylating Agents, Anti-HIV Agents-Other, and Emetogenic Therapy Adjuncts. Data and analysis by Avalere Health with funding from PhRMA.