Formulary Frontlines®
Comparative Review of DMARDs Coverage Across 3 Major Health Plans
07/25/2025
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As the multiple sclerosis (MS) treatment landscape grows more complex, payers must balance access with escalating drug costs. Our latest Formulary Frontlines report compares how Blue Cross Blue Shield, Cigna, and UnitedHealthcare manage coverage across key MS drug classes—revealing major differences in tier placement, access restrictions, and class inclusion.
Key Insights
- BCBS provides broadest access but places most therapies in high tiers with prior authorization.
- Cigna imposes the strictest controls, often layering PA, quantity limits, and non-extended day supply—even excluding entire drug classes.
- UnitedHealthcare takes a selective approach, with variable tiering and consistent use of dispensing and quantity limits.
What You'll Gain
- Side-by-side formulary comparisons across 6 MS drug classes, including anti-CD20 biologics and S1P modulators.
- Clear visibility into how tiering and utilization tools impact access and cost-sharing.
- Strategic insights to inform formulary design and optimize MS therapy coverage.
Download the full report to benchmark your MS formulary strategy in a dynamic specialty market.
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