https://www.cms.gov/research-statistics-data-and-systems/sta...
Program D’s client-payers identify MTM eligible patients based on each payer’s eligibility criteria.
While many commercial payers offer Program D services to all their employees (i.e. no eligibility criteria), Medicare Part D plans offer MTM to only a subset of their enrollees – those who meet the three criteria of having multiple drugs, multiple chronic conditions, and drug costs exceeding $4,000 – and most plans further refine this by including only patients with specific chronic conditions and drugs.

https://www.annallergy.org/article/S1081-1206(19)30087-0/ful...
Cost must be considered when choosing a biologic, including the ability to satisfy local payer eligibility criteria and the responsibility the patient as well as the payer will bear, including society for those receiving government insurance support.

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Note added at 2 hrs (2024-03-02 06:36:17 GMT)
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Сами критерии отбора пациентов плательщиком за препарат на с.24
https://ginasthma.org/wp-content/uploads/2019/04/GINA-Severe...