Formularies

Formularies

Optimal formulary placement is key to a product’s success. Our training prepares your sales team to position their products to pharmacy & therapeutics (P&T) committees and other key decision makers in a value-driven market.

Administering the Pharmacy Benefit

This module begins with a discussion of the role of prescription drugs in the delivery of healthcare services and what is meant by the pharmacy benefit. It then discusses the role of PBMs in managing the pharmacy benefit and how financial risk is influencing the pharmacy benefit.

Criteria for Product Approval to the Formulary

This module focuses on the formulary approval process in both managed care organizations and hospitals, and how decisions are made regarding which drugs are approved for formulary inclusion.

Formulary Design

This module describes three major formulary design concepts: open, closed, and incented or multi-tier, and discusses the emerging approach to formulary structure, and value-based formulary design.

Hospital and Managed Care Formularies

This module discusses the use of formularies in hospital and managed care/organized customer settings.

Medicare and Medicaid Formularies

This module explores the role of formularies in controlling healthcare costs under two major public programs--Medicare and Medicaid.

Role of Clinicians and Pharmacists in Managing the Pharmacy Benefit

This module focuses on the role of clinicians and pharmacists in pharmacy benefit management.

Selling in the Formulary Environment

This module discusses how pharmaceutical companies have responded to and are succeeding in a formulary environment.

Strategies for Managing the Pharmacy Benefit

This module describes the key methods used by health plans, insurers, and hospitals to manage the pharmacy benefit. These methods include: cost sharing through tiered formularies and higher copays, influencing prescribers' medication choices, implementing formulary control measures such as prior authorization and generic and therapeutic substitution, conducting periodic drug utilization evaluation (DUE) for specific products or entire classes, and implementing clinical practice guidelines, step therapy, and disease management programs to optimize pharmacological therapy. The module concludes by considering the possible effects on an insurer or MCO of managing a pharmacy benefit and formulary too restrictively.

The Managed Care Pharmacy

This module discusses current strategies for managing pharmacy coverage, the changing role of the pharmacist, and the role of pharmacy benefit management (PBM) companies.

The Pharmacy and Therapeutics Committee

This module focuses on the role of the P&T Committee in the formulary system. It describes the structure and functions of the P&T Committee and explains the actual drug approval process and the restrictions and limitations that might be imposed on a drug once it is approved. In addition, this module describes the criteria that are used to determine whether a drug is accepted for the formulary or rejected.

Why Formularies

This module discusses the rationale behind formularies and considers the advantages and disadvantages that come with their use.

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