New AIS Report Explores the Pros and Cons of Adopting Exclusionary Formularies

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PBM Formulary Exclusions: Bottom-Line Strategies for Health Plans, the latest report in Atlantic Information Services’ Management Insight Series, examines the rationale behind exclusionary formularies and outlines recommendations for how plan sponsors should respond.

Atlantic Information Services, Inc. (AIS) is pleased to announce the publication of PBM Formulary Exclusions: Bottom-Line Strategies for Health Plans, the latest report in its Management Insight Series. Formulary exclusion — where pharmacy benefit managers (PBMs) put some manufacturers in exclusive positions and remove other clinically comparable agents from their formularies — have been notably adopted by Catamaran Corp., CVS Caremark Corp. and Express Scripts. The report examines the rationale behind the practice and also offers advice to self-funded plan sponsors (of any size) on how to respond.

The report addresses these and other key issues:

  • Savings opportunities that exist with formularies that utilize standard exclusions.
  • Various exclusionary models in the marketplace today.
  • Why some plan sponsors are choosing to build around the exclusionary model and what this involves.
  • How plans can adopt an exclusionary formulary without major pushback from members, as well as the clinical process and communication strategy Express Scripts employed to avoid client and member disruption.
  • Key questions plan sponsors should ask of their PBMs when considering whether to opt in or out of the standard exclusions — and if they don’t opt in, what the estimated impact to their annual rebate revenue might be.
  • Specific clinical protocols that need to be implemented to achieve significant cost savings while also enabling members to receive coverage for the medication they truly need, and what plans can do to ensure specialty access to medications for chronically ill members.

For more information on PBM Formulary Exclusions: Bottom-Line Strategies for Health Plans, including a full table of contents, visit http://aishealth.com/marketplace/pbm-formulary-exclusions.

AIS’s Management Insight Series is designed to provide practical solutions to complex business challenges with the help of the industry’s most insightful advisors and managers. See a full list of titles in this series at http://aishealth.com/marketplace/insight-series.

About AIS
Atlantic Information Services, Inc. (AIS) is a publishing and information company that has been serving the health care industry for more than 25 years. It develops highly targeted news, data and strategic information for managers in hospitals, health plans, medical group practices, pharmaceutical companies and other health care organizations. AIS products include print and electronic newsletters, websites, looseleafs, books, strategic reports, databases, webinars and conferences. Learn more at http://AISHealth.com.

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Jill Brown, Executive Editor
Atlantic Information Services
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