Reference formularies (More on Pharmacy Best Practices, Aug. 2007)

August 1, 2007

Not designed to be used as a stand-alone formulary, reference formulary systems offer a baseline for employers to use to compare their current formulary with one optimized to achieve maximum cost savings and to maintain quality.

Not designed to be used as a stand-alone formulary, reference formulary systems offer a baseline for employers to use to compare their current formulary with one optimized to achieve maximum cost savings and to maintain quality.

Towers Perrin used value as a major factor in developing its new Reference Formulary System, which is the only design independent of variables traditionally associated with PBM decisions, such as plan design and financial factors–rebates and charge backs. Cost-shifting is not part of the solution.

Targeting plan sponsors, Towers Perrin's Reference Formulary focuses on five therapeutic categories that drive most of the utilization and cost. The anticipated result is a formulary that will accomplish these two goals.

He says that the new formulary system has saved employer groups and their employees 10% to 30% in pharmacy costs as they take advantage of predictive modeling to gauge the impact of formulary and benefit decisions on drug trends.

Although initial analysis does not indicate improvement in quality as Gilderman has suggested, Schott is confident that it will rise in the context of what the formulary is trying to do–balance quality and price which is not always about using generics but also brands that are high-quality and cost-effective.

"The formulary recommends high-value generics to brands to allow patients who need these drugs to find less expensive alternatives," adds Gary Owens, MD, a physician consultant for Towers Perrin. "We want to allow plan sponsors to show savings due to lower-cost products with the same outcomes," he says. "The formulary can become a dynamic tool for clinical management."