Formularies get stricter


Pharmaceuticals may be a modest piece of the health care pie, but modest doesn't mean insignificant. HMOs and pharmacy benefit managers, often working together, continue to put pressure on physicians to prescribe, and pharmacists to dispense, certain drugs. The formulary is the best-known device; many patients now know about this list of approved drugs. But there are many ways — involving prescriber, dispenser and consumer — in which cost-effective drug use is encouraged. (Data for 1997 and 1998 are projections.)

Trends in formulary control, 1995-98 chart

HMO, employer and PBM formulary design

The levels differ, but the trend is the same.

The open formulary is waning, the closed formulary gaining. Employers, who must be responsive to employees, understandably lag behind HMOs and PBMs, but they're moving in the same direction.

Source: PHARMACY BENEFIT REPORT, TRENDS AND FORECASTS, 1997 EDITION, NOVARTIS, EAST HANOVER, N.J.

Career Opportunities

HAP, a subsidiary of Henry Ford Health System, is a nonprofit health plan providing coverage to individuals, companies and organizations. This executive develops strategies to meet membership and revenue targets through products, pricing, market segmentation and advertising.  Aligns business among Business Development, Commercial Sales, Medicare and Public Sector Programs and Product Development. Seeks to enhance and be responsible for business development and expansion through the development of an effective product portfolio, strong interpersonal relationships and service excellence.

Apply via email to jfedder1@hfhs.org or online at http://p.rfer.us/HENRYFORDlXqAJA

Subscribe to Our Newsletters

Monthly table of contents

Be notified as each issue of Managed Care is available online.

Biweekly newsletter

Recent topics have included:

PTCommunity news

New drug approvals, clinical trials, drug management. Three times per week.

UP NEXT

Managed Care
By Peter Wehrwein
Managed Care
By Howard Wolinsky