Factors that affect formulary switching














New research from Express Scripts provides some important insights into the role of patient characteristics and plan design factors when it comes to getting members to switch to lower-tiered agents after a formulary status change. Of the patient-related factors that affected switching, being female, prior statin switching experience, and member outreach to the pharmacy benefit manager consistently and positively influenced switching. Step therapy, brand preferred/nonpreferred copayment differences, and receipt of a response letter alerting the member to the switch positively influenced switching.

Compared to members with a brand preferred/nonpreferred copayment difference of less than $16, members with copayment differences of $16–$30, $31–$40, and $41 and higher were more likely to switch to a preferred agent (20 percent, 23 percent, and 59 percent of the time, respectively). Ellen Cox, director of research at Express Scripts, says, “There is a basic fundamental — the greater the price differential, the more likely the member will switch. That doesn’t mean that the plan makes the branded product financially burdensome; it could reduce the cost of the generic to create that price differential.”

Source: Cox ER, et al. 2007. Ann Pharmacother.41;1946–1953.

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

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