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PBM practices surrounding formulary management have come under intense scrutiny recently. How PBMs collect rebates on formulary products is a topic of much discussion and speculation, even as PBMs continue to keep confidential many details on rebate collection from pharmaceutical manufacturers. In this book, Tim Watson shares his insight into the formulary management strategies and practices of the nation's leading PBMs. Each PBM has a distinct approach to formulary management. By understanding these distinctions, payers will be in a better position to:
Watson provides detailed formulary comparisons for selected therapeutic classes, and detailed examples of how formulary management may be approached in the future. This comprehensive guide will provide payers with the necessary tools to conduct more detailed formulary comparisons between various PBM vendors-leading to a renewed alignment of business goals between PBMs and their customers. This guide provides payers and interested parties with insight into the formulary management tools and practices offered by some of the leading PBMs:
The formulary strategy employed by a PBM will have a material impact on the overall medication use in a payer's population and the resulting overall cost. Understanding the differences in PBM formulary positioning is key to understanding how overall costs can vary between PBMs. In an ideal
world, payers would be able to compare PBMs on the net cost of drugs
(ingredient costs and rebates). However, some PBMs are unwilling or
unable to share net cost information. Watson provides specific formulas
and comparison points to help you calculate the impact of a particular
PBM formulary on your own plan population.
Introduction Chapter
1 Chapter
2 Chapter
3 Chapter
4 Chapter
5 Appendix
1
Appendix
2 Appendix
3
Tim Watson, Pharm.D., M.B.A. is President of Pharmaceutical Strategies Group, LLC, in Dallas, Texas. He has over 10 years of experience in the health care arena with a focus on the pharmaceutical marketplace. He specializes in providing strategic planning, market research, and pharmacy program management services to a diverse group of clients.
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