Prescription medication coverage is one of the most expensive components of a health plan for a state agency or health care organization. When a new medication or product becomes available, our clinical staff conducts a thorough evaluation process to determine if we should place the new product on the formulary list or if it should remain a non-preferred drug. This can include:
- Medical literature review
- Cost-benefit analysis development
- Data monograph creation, including comparisons to currently available products and/or formulations
- Presentation at Pharmacy and Therapeutics Committee and/or Drug Utilization Review Board meetings
As we design our clients’ drug lists and formularies, we consider these key factors:
- New-to-market drug reviews
- Clinical guidelines
- Therapeutic class reviews
- Pharmacoeconomic analysis
- Drug file changes
A formulary can encourage providers to try less costly alternatives – including generics – for their patients first, before moving to higher-priced options if the initial choice does not produce the desired results. This allows Medicaid and managed care plans to provide high-quality care while working to also contain escalating drug costs.
