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

Trends that Matter for Formulary Insights

Posted by Matt Breese on Dec 24, 2015

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Pharmaceutical manufacturers, payers, providers and patients leverage formulary data for informed decision-making. Thousands of U.S. formularies map to nearly 7,000 plans across the country, creating an increasingly complex landscape. Healthcare companies across the network utilize formulary data and insights in a variety ways, as highlighted from the following links:


Avalere analyzes drug coverage for health exchange plans and identifies the prevalence of specialty tier placement.


"A subset of plans in each of 10 drug classes1placed all single-source branded drugs in a class on a specialty tier. Specifically, in 8 of the 10 classes, 2015 exchange plans were more likely than 2014 plans to assign all single-source branded drugs to the highest cost sharing tier. A single-source branded medication is a brand name drug without a generic equivalent." Avalere leveraged MMIT data representing silver marketplace exchange plans in 6 states. Read More.


Managed Care Mag highlights the delicate balance between cost and benefit when it comes to high-cost drugs.


Leveraging formulary data to better understand how a high cost, high value antiviral pharmaceutical, Sovaldi, is covered by health plans across each channel provides insightful drug trend insights. Read More.


Pharmaceutical manufacturers, like Antares Pharma, leverage formulary data to develop key prescription drug coverage takeaways.

From an earnings call, Antares Pharma explains to investors, "Prescription drug coverage for OTREXUP, as reported by MMIT, a formulary coverage service provider for more than 4,000 plans, commercial plans, shows that 90% of commercial lives have some form of coverage and 48% either have referred, preferred or good access, just requiring a prior authorization to oral methotrexate." Read More via Seeking Alpha.


The California Healthcare Foundation describes formulary data as a key channel for improved consumer education on prescription drug coverage.


Accurate and timely formulary data is essential in enabling more informed decisions from consumers. Changing industry guidelines inspire more investment in member communications from payers like CaliforniaChoice. A recent study provides some insights on how patients currently access formulary data and their preference for data display, whether through an online tool or a mobile application. Read More.


Health care professionals leverage market-facing applications to quickly understand drug coverage for patients at the point of care.

A recent post from the Nurse Practivity blog highlights an example of how accurate formulary data streamlines patient engagement. "You can enter any prescription drug plan to see if a medication is covered!  If the med is not covered you can see what therapeutic alternatives are preferred." Read More.

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Topics: Industry Trends, Market Access, Provider, Payer