Rising drug prices and shifting drug development pipelines are now norms that will continue to shape payer and PBM formulary and policy strategies. Pharmacy directors and health plan formulary managers are tasked with maintaining the delicate ecosystem of how pharmaceuticals are covered and reimbursed. This challenge might be more intensive than ever before in 2017.
Prescribers, now inundated with conflicting data sources, are challenged to confidently navigate formulary complexities. Meanwhile, pharma continues to address new disease areas and infuse highly managed products into the market. Payers implement strategies to control costs while not overstepping existing regulation and policies that govern their every move.
Based on feedback from our payer and PBM clients, we've compiled a list of the top 5 formulary management and publishing challenges in 2017:
- Utilization Management Complexity: The growth of specialty drugs and the prevalence of associated restrictions requires formularies to outline relevant prior authorization and step edit details. Ensure your formulary clearly communicates drug policy details affecting coverage to streamline provider’s scripts.
- Demand for Real-time Updates: An increasingly tech-savvy market needs near real-time communication of formulary updates. Providers continue prescribing, regardless of how long it takes coverage updates to reach your guidebooks or website. Build prescribing confidence by providing rapid access to formulary details that help providers select the best therapeutic option at every stage of the patient encounter.
- Complex Formulary Management: From P&T decisions to prescription fulfillment, payers and PBMs develop and continually refine sophisticated cost containment strategies. The growth of highly managed products, often with higher price-tags, demands extensive formulary planning, execution and monitoring. Leverage sophisticated decision support solutions that turn advanced formulary management into your competitive advantage.
- Government Workflow Simplification: Whether cross-checking Medicare Part D formularies with CMS guidelines or validating health exchange formularies meet required benchmarks, implement automated and proven solutions to control formulary workflows.
- Clinical Workflow and Prescribing Support: Formularies are complex and providers reference multiple formularies covering broad patient populations. Support confident prescribing by delivering comprehensive formulary reference material that easily integrates with clinical workflows.
Are you a payer or PBM that's dealing with these same challenges? We'll be at PBMI next week if you'd like to discuss further.
Stay tuned for more perspectives on payer and PBM challenges, especially related to drug market access (it's all we do). If you find this topic of interest, we've included some related posts below. As always, you can subscribe for notifications (to the right) when we post related content.