Lumara Series Episode 2: The Coverage Chessboard

The Coverage Chessboard — Formulary Status and Rebate Wars

Episode 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 learn

• How tiering, step edits, and prior auths actually play out in severe asthma

• The levers that move a product to preferred status

• National vs. regional plan differences — and what to watch in Part D

• When to rebate to win vs. pilot value-based and outcomes-based contracts

Featured segments

• What Gets You Preferred?

• Inside P&T: From Step Edits to PA Evidence

• Playbook Options: Rebates, Outcomes Deals, and Regional Pilots