Formulary Management

Formulary management is the cornerstone of cost containment. Payors who are currently aligned to a broad formulary without exclusions could find significant savings opportunities by adopting a narrower formulary. We continually monitor the pharmaceutical landscape and evolve our formulary strategy to help clients stay ahead of marketplace trends, while offering members access to clinically appropriate, cost-effective medications.

Clients aligned to our template formularies are expected to save $4.3 billion in 2023.

Clients aligned to our Standard Control Formulary (SCF) have realized much greater savings than clients who have opted for a broad formulary with no drug exclusions, and it covers all generics and most brand drugs. However, moving beyond SCF and aligning to a more tightly managed formulary, such as Advanced Control Formulary (ACF) or Value Formulary (VF), could help deliver significantly greater savings.

Standard Control Formulary

Our SCF offers the broadest coverage of generics and most brands, including specialty medications. Updates are made at the beginning of the year with potential quarterly removals for hyperinflation and specialty products. It offers savings of up to 2 percent on pharmacy spending.

Advanced Control Formulary

ACF delivers greater savings while promoting cost-effective care through increased rebates and generic utilization driven by tighter controls. Utilization management programs for specialty treatments are included along with the appropriate plan design for greater savings. It covers select generics and brands and can deliver gross pharmacy savings of up to 5 percent and an increase in generic dispensing of up to 1 percent.

Advanced Control Specialty Formulary

Advance Control Specialty Formulary (ACSF) incorporates multiple strategies for a proactive approach to managing specialty costs. This includes Specialty Guideline Management to help ensure clinical appropriateness, drug safety and effectiveness. It targets specialty drug classes that may be experiencing significant growth in number of drugs available or drug cost and utilizes quarterly auto-updates to address shifts in the rapidly changing market, including tier changes and new-to-market products. ACSF promotes generics first to increase utilization of lower-cost, clinically appropriate options where available.

Value Formulary

VF covers most generics and select brands across all disease states and can deliver up to 6 percent in savings and an increase in generic dispensing of up to 4 percent. It represents our most progressive approach to drug coverage for our commercial clients and delivers significant savings by prioritizing generic utilization across all disease states. It combines a closely managed drug list and an array of clinical programs — including step therapy, prior authorization and quantity limits — across therapeutic classes.

Effective formulary management strategies help clients manage costs and ensure members have access to clinically appropriate medications.

Want to learn how our formulary strategies can help manage costs? Ask Us