- Drug Coverage
- Hypertrophic Cardiomyopathy (HCM)
- Vaccines: 2023 Year in Review
- Eyecare
- Urothelial Carcinoma
- Women's Health
- Hemophilia
- Heart Failure
- Vaccines
- Neonatal Care
- NSCLC
- Type II Inflammation
- Substance Use Disorder
- Gene Therapy
- Lung Cancer
- Spinal Muscular Atrophy
- HIV
- Post-Acute Care
- Liver Disease
- Pulmonary Arterial Hypertension
- Safety & Recalls
- Biologics
- Asthma
- Atrial Fibrillation
- Type I Diabetes
- RSV
- COVID-19
- Cardiovascular Diseases
- Breast Cancer
- Prescription Digital Therapeutics
- Reproductive Health
- The Improving Patient Access Podcast
- Blood Cancer
- Ulcerative Colitis
- Respiratory Conditions
- Multiple Sclerosis
- Digital Health
- Population Health
- Sleep Disorders
- Biosimilars
- Plaque Psoriasis
- Leukemia and Lymphoma
- Oncology
- Pediatrics
- Urology
- Obstetrics-Gynecology & Women's Health
- Opioids
- Solid Tumors
- Autoimmune Diseases
- Dermatology
- Diabetes
- Mental Health
Reference formularies (More on Pharmacy Best Practices, Aug. 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."
A Conversation With Greg Baker, RPh, CEO of AffirmedRx
March 31st 2024Greg Baker, CEO of AffirmedRx, describes his early career, shares some of his critical opinions about the pharmacy benefit management (PBM) industry and how, in his view, his company is offering a better alternative.
Read More
David Calabrese of OptumRx Talks New Role, Market Insulin Prices and Other Topics 'On His Mind'
April 13th 2023In this month’s episode of the "What's On Your Mind podcast," Peter Wehrwein, managing editor of MHE connects with the now Chief Clinical Officer of OptumRx Integrated Pharmacies, David Calabrese. In this conversation, David touches on his transition in January as OptumRx’s former chief pharmacy officer and market president of health plans and PBMs to his new role as Chief Clinical Officer where he now focuses more on things such as specialty pharmacy to home delivery — with an overall goal of creating whole-patient care. Throughout the conversation, Calabrese also touched on the market’s hot topic of insulin prices and behavioral health services within the OptumRx community, among other topics.
Listen
Florida Gets the OK. But Will Drug Importation from Canada Actually Happen?
March 5th 2024Canadian health officials warn that maintaining a drug supply for Canadians is their priority. The staunch opposition of the U.S. pharmaceutical industry may also be an obstacle to imports from north of the border.
Read More
Briana Contreras, editor of Managed Healthcare Executive, spoke with Nancy Lurker, CEO and president of EyePoint Pharmaceuticals. Nancy shared a bit about EyePoint and how the organization’s innovative therapies are addressing patient needs through eye care, and most importantly, she addressed C-Suite positions like the CEO role. Nancy shared advice for those seeking to reach the CEO level, especially toward women in healthcare and other roles, and what it takes to run a biopharma company.
Listen
What Payers Need to Know As Retail Pharmacies Move Into Primary Care
September 6th 2023Healthcare beyond the doors of the doctor’s office has the potential to offer more care to more people. But payers need to think about how to ensure that care is consistent. Regardless of the setting, care decisions must be based on evidence-based content and supported with strong patient education.
Read More
