Formulary guidance and transparency from P&T to point of care

Formulary Search Rebrand Enhances the Big Picture, Adds Medical Benefit View

Posted by MMIT on Jun 13, 2019


MMIT on July 1 will rebrand Formulary Search as Coverage Search, a move that reflects the full portfolio of our capabilities, as well as the complex variances between pharmacy and medical benefit coverage, and the industry's shift toward increasingly restrictive coverage policies. You will be able to add a comprehensive new package on medical benefit coverage and policies, creating a more complete picture of the entire market access landscape.

New Medical Benefit View: "Previously, clients would think Formulary Search means formularies, so it means pharmacy benefit products only. But now we can help brands create a more complex strategy so that they can speak to coverage across benefit types," says Greg Lee, a product manager at MMIT. "This is a really important thing for our clients, because the way insurance companies are covering products — particularly physician-injected drugs, IV drugs and hospital-administered drugs — is changing, and insurance companies are getting more complex in how they create utilization management techniques on both benefits."
App Changes Tackle Uncertainty: Some drugs, particularly oncology products and specialty biologics, can be covered under both the medical and pharmacy benefit, and Lee says this creates a level of nuance health care providers can struggle with. "If they do buy-and-bill, will it be reimbursed? Or if it's a drug that the patient can potentially obtain through a specialty pharmacy, is that the better approach?"
Coverage Search's new capabilities can display benefit information that can tackle this uncertainty. "It allows companies to be more complex and more nuanced in their discussion of coverage for these brands that are being covered in different ways," Lee says.

Solutions That Fit Your Needs: With the introduction of Coverage Search, our Client Success Leads (CSLs) can provide you with a full picture of the dynamic between the pharmacy benefit and the medical benefit, and create configured solutions that best fit a brand's promotional needs. Lee says the custom status can highlight the most important restriction(s) information for any product. "If you're talking with an oncologist, the strategy is to highlight the fact that the insurance company is covering the product to National Comprehensive Cancer Network (NCCN) guidelines, or to the product’s label," Lee gives as an example. "The CSL will work to understand what the product's label is, what the guidelines are, how that compares to the restrictions that MMIT is assessing, and then create a custom status that allows the client to promote on access that is covered to label, or covered to NCCN recommendations, and that really allows a promotional strategy that's very specific to that product as well as the indication."

The new version of the application will available for download from the Apple App store and the Google Play store July 1.


Topics: Market Access, Product Release