In their insightful work, Hydery and Reddy (2024) offer a comprehensive overview of drug formularies. Let’s delve into the essentials.
Understanding Formularies
A formulary is a dynamic list of medications, products, and technologies supported by evidence-based medicine and expert judgment. Its purpose is to ensure access to appropriate therapy while optimizing resource utilization for managed care pharmacy organizations.
Different Formulary Structures
- Closed formularies do not cover excluded products.
- Open formularies cover all products available but may lead to higher costs.
- Tiered formularies categorize products into tiers affecting patient out-of-pocket costs.
- Value-based formularies use cost-effectiveness analysis to assign copayments based on product value.
Payer Considerations in Formulary Development
Key Trends in Formulary Development
Emerging trends include the rise of biosimilars, prescription digital therapeutics, and a growing focus on health equity.
