Building the Outcomes-Based Formulary
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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.
KeywordsHealth 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.
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