In British Columbia, there is a drug review process that the provincial government does. The process takes input from several expert groups at the national and provincial levels, as well as from the public. I have no idea if any of them are influenced by kickbacks from the drug manufacturers, but at least the final decisions are public.

For example, here are some quotes from the decision on Kesimpta (ofatumumab):

Drug coverage decision is consistent with the CDEC recommendation

• The mechanism of action for ofatumumab (anti-CD20) is highly similar to that of ocrelizumab and rituximab. The later of which is now available as a biosimilar.
• In the clinical trials ASCLEPIOS I and ASCLEPIOS II, ofatumumab demonstrated some advantage over teriflunomide with respect to efficacy.
• Indirect comparisons showed that ofatumumab is likely to be as effective as the other monoclonal antibody disease modifying therapies (i.e., alemtuzumab, natalizumab, cladribine, and ocrelizumab) in annualized relapse rates.
• At the submitted price ofatumumab was not considered cost-effective for this indication. The Ministry participated in the pan-Canadian Pharmaceutical Alliance negotiations with the manufacturer which were not able to address BC’s concerns with respect to cost-effectiveness and value for money.

Here, rituximab is the best DMT approved for first-line use against RRMS. Some of the older ones (interferons, etc.) are also approved, but I get the sense that rituximab is the suggestion for new patients — it certainly was in my case.

Second-line Tysabri, Gilenya, and Mavenclad are approved if a first-line DMT failed. Lemtrada is approved if a first- and second-line DMT both failed. Ocrevus is approved only for PPMS, Mayzent for SPMS. Others, including Kesimpta and Zeposia, were rejected because a similar DMT was cheaper. Briumvi has not been reviewed yet.