PBM practices surrounding formulary management have come under intense scrutiny recently. How PBMs collect rebates on formulary products is a topic of much discussion and speculation, even as PBMs continue to keep confidential many details on rebate collection from pharmaceutical manufacturers.
In this book, Tim Watson shares his insight into the formulary management strategies and practices of the nation's leading PBMs.
Each PBM has a distinct approach to formulary management. By understanding these distinctions, payers will be in a better position to:
- Select the right PBM for the job
- Evaluate the effectiveness of PBM programs and services
- Provide appropriate input and oversight into the formulary management process
Watson provides detailed formulary comparisons for selected therapeutic classes, and detailed examples of how formulary management may be approached in the future. This comprehensive guide will provide payers with the necessary tools to conduct more detailed formulary comparisons between various PBM vendors-leading to a renewed alignment of business goals between PBMs and their customers.
This guide provides payers and interested parties with insight into the formulary management tools and practices offered by some of the leading PBMs:
- AdvancePCS
- CaremarkRx
- Express Scripts
- Medco Health Solutions
- Aetna Pharmacy Management
- WellPoint Pharmacy Management
- Eckerd Health Services
The formulary strategy employed by a PBM will have a material impact on the overall medication use in a payer's population — and the resulting overall cost. Understanding the differences in PBM formulary positioning is key to understanding how overall costs can vary between PBMs.
In an ideal world, payers would be able to compare PBMs on the net cost of drugs (ingredient costs and rebates). However, some PBMs are unwilling or unable to share net cost information. Watson provides specific formulas and comparison points to help you calculate the impact of a particular PBM formulary on your own plan population.
Table of Contents
Introduction
The Importance of Formulary Management
Chapter 1
Overview of Formulary Processes at Four Leading PBMs
Chapter 2
Comparison of PBM Formularies in Key Therapeutic Classes
Chapter 3
Comparing the Relative Value of PBM Formularies
Chapter 4
Future Formulary Management Tools
Chapter 5
Description of Resources Available to Assist Payers in Formulary Management
Appendix 1
Oregon Health Resources Commission
HMG-CoA Reductase Inhibitors Subcommittee Report
Proton Pump Inhibitors Subcommittee Report
Appendix 2
Principles of a Sound Drug Formulary System
Appendix 3
Pharmaceutical Care Management Association
Written For
Managers of HMOs, PPOs, and other managed care companies
Purchasers, employers, and Pharmacy Benefit Management companies
Managers in the pharmaceutical industry
Health plans and medical groups
Unions
Insurance payers
Network contractors
International orders will be fulfilled in PDF format via email.
