Episode 2: The Coverage Chessboard

13/10/2025 11 min
Episode 2: The Coverage Chessboard

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Episode Synopsis

The Coverage Chessboard — Formulary Status and Rebate WarsEpisode 2 dives into the real engine of access: how plans decide who gets preferred, who gets blocked, and what it really costs to move tiers. We unpack the payer dynamics shaping severe asthma today—tiering norms, step edits, and prior auth criteria—then walk through what wins preferred placement: net price after rebates, label breadth and real-world outcomes, ease of administration, and the quality of patient services. You’ll also hear how the competitive set (Dupixent, Tezspire, Fasenra, Nucala) influences plan logic across Commercial, Medicare Part D, Medicaid, and regional MCOs, plus why pre-launch engagement and contracting transparency are rising expectations. What you’ll learnHow tiering, step edits, and prior auths actually play out in severe asthmaThe levers that move a product to preferred statusNational vs. regional plan differences — and what to watch in Part DWhen to rebate to win vs. pilot value-based and outcomes-based contractsFeatured segmentsWhat Gets You Preferred?Inside P&T: From Step Edits to PA EvidencePlaybook Options: Rebates, Outcomes Deals, and Regional Pilots