Drug Formulary and Prior Authorization Criteria

Prescription medications are one of the most rapidly increasing expenditures for a state agency or health care organization. When a new medicine becomes available, our pharmacists conduct a thorough evaluation of pipeline literature and refer to our curated library of 250 therapeutic guidelines containing clinical criteria for thousands of medications to determine the appropriate placement on a payer's drug list or formulary.

We recommend prior authorization criteria to promote optimal use and present our findings to your Pharmacy and Therapeutics Committee and/or Drug Utilization Review Board meetings. Our evaluation process includes:

  • Evidence-based medicine literature review
  • Consideration of economic implications
  • Drug monograph creation, including comparisons to currently available products or formulations

We have demonstrated a return-on-investment of $5:1 for one client's carved-out prior authorization program.