Disease Management & Health Outcomes

, Volume 10, Issue 8, pp 473–477 | Cite as

Building the Outcomes-Based Formulary

  • Brian T. Sweet
  • Marcus D. Wilson
  • William J. Waugh
  • Andrea D. Hess
  • Joshua J. Spooner
Practical Disease Management


The traditional formulary review process possesses limitations that impair a Pharmacy and Therapeutics committee’s ability to thoroughly evaluate products, including the lack of emphasis on a product’s impact on humanistic outcomes and the use of cost comparisons which fail to evaluate the budgetary impact on all aspects of medical expenses. Emerging formulary submission guidelines offer some improvements to these traditional reviews, but fail to address several key issues; most notably these guidelines do not impart provisions for the completion of needed outcomes research.

Designed to facilitate the collaboration of the manufacturer, health plan, and outcomes research organization in the design, conduct, and completion of outcomes research, WellPoint Pharmacy Management’s Outcomes-Based Formulary helps to limit or eliminate gaps of information in the product portfolio while ensuring that the patient population studied matches that of the health plan. The Outcomes-Based Formulary will provide a participating health plan’s Pharmacy and Therapeutics committee with a wealth of information, including effectiveness and humanistic data, with which the most informed formulary decisions can be made.


Health Plan Product Portfolio Product Review Formulary Review Average Wholesale Price 



None of the authors have any potential conflicts of interest that are directly relevant to the contents of this manuscript. The authors wish to thank John J. Barron, Pharm.D., Michael F. Bullano, Pharm.D., and Vincent J. Willey, Pharm.D. for their assistance in the preparation of this manuscript.


  1. 1.
    Dillon MJ. Drug formulary management. In: Navarro RP, editor. Managed care pharmacy practice. Gaithersburg (MD): Aspen, 1999: 145–66.Google Scholar
  2. 2.
    Goldberg RB. Managing the pharmacy benefit: the formulary system. J Managed Care Pharm 1997; 3: 565–73.Google Scholar
  3. 3.
    Mistry SK, Spooner JJ. The economics of pharmacotherapeutics. In: Arcangelo VP, Peterson AM, editors. Pharmacotherapeutics for advanced practice. Philadelphia (PA): Lippincott, 2001: 13–20.Google Scholar
  4. 4.
    CareData Reports, Inc. 1998 Health plan member survey of 25,505 commercial health plan members. New York (NY): CareData Reports, 1998.Google Scholar
  5. 5.
    Commonwealth Department of Health, Housing, and Community Services. Guidelines for the pharmaceutical industry on the preparation of submissions to the Pharmaceutical Benefits Advisory Committee. Canberra: Australian Government Publishing Service, 1992.Google Scholar
  6. 6.
    Ontario Ministry of Health. Ontario guidelines for the economic analysis of pharmaceuticals. Toronto (ON): Ministry of Health, 1994.Google Scholar
  7. 7.
    Langley PC. Formulary submission guidelines for Blue Cross and Blue Shield of Colorado and Nevada: structure, application and manufacturer responsibilities. Pharmacoeconomics 1999; 16: 211–24.PubMedCrossRefGoogle Scholar
  8. 8.
    Langley PC, Martin RE. Guidelines for formulary submission. Rancho Cordova (CA): Foundation Health and Integrated Pharmaceutical Services, 1996.Google Scholar
  9. 9.
    Regence Washington Health Pharmacy Services. Guidelines for the submission of clinical and economic data supporting formulary consideration. Seattle (WA): Regence Washington Health, 1997.Google Scholar
  10. 10.
    Academy of Managed Care Pharmacy. A format for the submission of clinical and economic evaluation data in support of formulary consideration by managed health care systems in the United States. Alexandria (VA): Academy of Managed Care Pharmacy, 2000.Google Scholar
  11. 11.
    National Committee for Quality Assurance. Medicare health outcomes survey manual. Washington, DC: NCQA Publications, 2000.Google Scholar
  12. 12.
    Langley PC, Sullivan SD. Pharmacoeconomic evaluations: guidelines for drug purchasers. J Managed Care Pharm 1996; 2: 671–7.Google Scholar
  13. 13.
    Atherly DE, Sullivan SD, Fullerton DS, et al. Incorporating clinical outcomes and economic consequences into drug formulary decisions: evaluation of 30 months of experience. International Society for Pharmacoeconomics and Outcomes Research Sixth International Meeting; 2001 May 21, Arlington (VA).Google Scholar
  14. 14.
    Hrachovec J, Watkins J. Challenges and expectations for MCOs: update and future directions. Academy of Managed Care Pharmacy 2001 Educational Conference; 2001 Oct 19, Dallas (TX).Google Scholar

Copyright information

© Adis International Limited 2002

Authors and Affiliations

  • Brian T. Sweet
    • 1
    • 2
  • Marcus D. Wilson
    • 2
  • William J. Waugh
    • 1
  • Andrea D. Hess
    • 1
  • Joshua J. Spooner
    • 2
  1. 1.WellPoint Pharmacy ManagementWest HillsUSA
  2. 2.Health Core, Inc.NewarkUSA

Personalised recommendations