Best Practices in Formulary Success: Key Payer Responsibilities and Pharma Support

STUDY OVERVIEW

Pharmaceutical field medical team (FMT) interactions with payers have risen in importance as the influence of payers has dramatically increased. As the healthcare market shifts to a value-based system, a new product’s position on a formulary is now as important as its reception among prescribers and KOLs. Recognizing this trend, pharma is paying more attention to the roles and responsibilities of payers, especially how they relate to formulary decisions.

This study explores the key responsibilities/activities of payers in leadership positions (pharmacy directors, medical directors, etc.) and how pharma supports these payer activities.

KEY TOPICS

• Executive Summary: Methodology, Participants, & Key Findings
• Primary Responsibilities and Payer Support

KEY METRICS

• How much time do you spend on reviewing clinical data and making recommendations & how do pharma companies help you in conducting this activity?
• How much time do you spend on developing formulary policy decisions & how do pharma companies help you in conducting this activity?
• How much time do you spend on ensuring compliance with healthcare delivery programs & how do pharma companies help you in conducting this activity?
• How much time do you spend on developing or implementing pathway decisions & how do pharma companies help you in conducting this activity?
• How much time do you spend on modifying programs due to changes in law & how do pharma companies help you in conducting this activity?
  

• Respondents representing the two principal types of payers in this study, MCOs and PBMs, share the same two principal responsibilities and said they spend a significant amount of their time on them:
  • Reviewing clinical data and making recommendations
  • Developing formulary policy decisions

METHODOLOGY

This study engaged a total of 23 formulary leaders from at least 16 managed care organizations. Medical directors represented more than 40% of the respondents.

Industries Profiled:
Insurance; Health Care; Medical


Companies Profiled:
Anthem; UnityPoint Health; HCA; St. Joseph's Health; Kaiser Permanente; Ascension; Express Scripts; Cleveland Clinic; Inc.; University Hospitals; WellSpan Health; Aetna; CVS Health; Humana; DaVita; Tenet Healthcare ; MedImpact

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