Table 3.
Characteristics associated with more restrictive coverage
| Odds ratio (95% CI) | |
|---|---|
| Total, N | 1181 |
| Cancer treatment | 0.019** (0.008–0.041) |
| Pediatric population | 11.558** (3.906–34.203) |
| FDA line of therapy | |
| 1 | Reference |
| 2 | 0.521 (0.270–1.007) |
| First biosimilar | 0.225** (0.118–0.429) |
| Years since market launch | 0.823 (0.659–1.028) |
| No. of competitors | |
| 1 | Reference |
| 2 | 0.060* (0.006–0.586) |
| 3+ | 3.194 (0.462–22.082) |
| Disease prevalence | |
| < 200,000 | Reference |
| 200,000–1,000,000 | 2.000 (0.854–4.685) |
| > 1,000,000 | 2.067* (1.060–4.029) |
| Annual savings per patient | |
| < $5,000 | Reference |
| $5,000–$9,999 | 0.534 (0.273–1.046) |
| $10,000–$15,000 | 0.474 (0.213–1.055) |
| > $15,000 | 0.171** (0.057–0.514) |
| Coverage of reference product relative to FDA label | |
| Not more restrictive | Reference |
| More restrictive | 0.065** (0.038–0.109) |
| Cost-effectiveness measure availability of the reference product | |
| Available | Reference |
| Not available | 0.066** (0.023–0.186) |
| Plan size | |
| National | Reference |
| Regional | 1.511 (0.981–2.329) |
| Pharmacy benefit manager | |
| Big Threea | Reference |
| Other | 1.683* (1.129-2.507) |
CI confidence interval
*p < 0.05, **p < 0.01
aBig Three included CVS Caremark, Express Scripts, and OptumRx