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

Perspectives on Preferred and Exclusion Lists

Posted by Matt Breese on Apr 4, 2017

Find me on:

Preferred and Exclusion Lists.png

Pharma brand teams that monitor preferred and exclusion list releases have a better understanding of market access. These resources help pharma companies predict performance for their brands and competitive brands. Tracking significant changes in placement on preferred and exclusion lists also helps forecast brand revenue.

Placement on a preferred drug list (PDL) indicates promising market access. According to Allen Christensen, Utah State Senator and former Chair of the Health and Human Services Committee:

“A preferred drug list is a list of drugs that are selected based on results of extensive and recurring medical research that examines effectiveness, safety and cost. Because of the amount of research done, insurance companies use the lists to guide patients to the most effective drug.” 

In contrast, placement on an exclusion list creates a disadvantaged situation for access. A formulary exclusion list is a list of prescription drugs that are not covered by a particular healthcare plan. If a consumer needs a drug on this list, medical professionals must ask for special coverage.

Managing Preferred or Exclusion List Placement

To influence placement, it is important for pharma companies to know the timeline when payers make decisions for preferred and exclusion lists. Pharma brands should review all payer accounts that are heavily weighted for their prescribers.  In addition, pharma must identify disadvantaged situations where a competitor is on a PDF or their brand is a candidate for an exclusion list.

Specifically, here’s one approach developed by MMIT for identifying coverage risks from probable exclusion list placement:

Exclusion List Placement.png

According to Outsourcing Pharma, rebates to PBMs from drug manufacturers often impact exclusion decisions. To overcome exclusion list challenges, brand teams should focus on developing payer contracts or rebates.

The Growth of Exclusion Lists

Exclusion lists are growing with the evolving, value-based market. In fact, the number of drugs on the exclusion lists of the two largest PBMs in the U.S. increased by approximately 65% from 2014 to 2016, according to Tufts University.

Further research in the Journal of Clinical Pathways supported this trend:

“The use of formulary exclusion lists is expanding—and such lists are beginning to shape the market by further limiting available drugs for narrow therapeutic areas while reducing redundancy of options in broader ones. This trend suggests a need for careful evaluation by pharma to demonstrate the value of their products for defined patient populations and for payers to balance short-term cost management pressures with broader population health needs.”

In the case of an exclusion listing, pharma brands marketers must ensure that brand truths are communicated through PAR messaging in the language of the provider. To learn more pharma marketing strategies, view MMIT's Playbook: Preferred or Exclusion List Placement. 

Subscribe to the MMIT blog for more pharma, provider, and payer perspectives on key topics that affect the healthcare network.

Subscribe for Weekly Perspectives

Topics: Industry Trends, Branding & Marketing