Featured Topic
Unified Formulary
A drug formulary, or preferred drug list, is a continually updated list of medications and related products covered by insurance. A unified formulary provides savings opportunities for those states that use Medicaid managed care.
What Challenges You
Members who change managed care plans may have a different formulary and will need to try other medications, interrupting continuity of care. Managed care plans often choose the lowest gross (list) price drugs for their formulary, which may not offer the lower cost to the state after rebates (net price). States may be missing out on significant savings (in some cases up to 10% of pharmaceutical spend). On top of that, Medicaid agencies often lack the analytical and operational resources to plan and execute creating a single unified formulary.
A Unified Formulary ensures a WIN-WIN-WIN for all involved:
- Members receive continuity of and equitable care – the drug follows the member through different plans.
- Providers only have to deal with one formulary for all plans, decreasing burdens on an already stretched workforce.
- Medicaid programs would see a lower overall spend for drug costs by maximizing rebates to the state.
How We Can Help
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1
We deliver knowledge and resources to assist with the creation and implementation of a state’s customized UF with clinical management recommendations and assistance with communication to managed care plans and their Pharmacy Benefit Managers. -
2
Our experts ensure that formularies are based on clinical data and guidelines while maximizing rebates. -
3
Our services include pipeline monitoring and regular updates to the UF to respond to clinical and financial challenges.
Our Impact
One of our clients saved $110 million* in 2021 because of the UF initiative.
We developed a partial UF for one state’s Medicaid Pharmacy Program, unifying all therapeutic classes into one formulary and also aligning incentives for managed care plans to ensure full compliance.
*represents approximate amount
