Should PBMs work with physicians to develop formularies?(Pro & Con)

YES The job of managing the pharmacy benefit is an essential element of the overall health care management equation. Left unmanaged, plan sponsors' costs would rise at faster rates, with the ultimate result of reduced benefits and higher costs to consumers.

Drug formularies are essential tools for pharmacy benefit management, enabling health benefit plans to provide appropriate and cost-effective prescription drug benefits to consumers. Express Scripts and other pharmacy benefit managers (PBMs) develop drug formularies and other formulary management tools to improve drug therapy and make the cost of prescription drugs more affordable for prescription benefit plans and their members.

The process that Express Scripts uses to develop formularies has been constructed to ensure that clinical considerations are paramount and fully taken into account before cost considerations. Express Scripts also ensures that each drug is considered individually on its own merits.

Our pharmacy and therapeutics committee performs each clinical evaluation. The committee's membership consists of 19 independent physician members in active practices or on staff at well-known medical schools.

When evaluating drugs, the committee reviews Food and Drug Administration documentation, peer-reviewed published research, and information from manufacturers. It has access only to publicly available price information, such as the average wholesale price. The committee has no information regarding negotiated discounts or any other business concerns.

After the committee has made its clinical recommendations, the company develops specific formulary recommendations. These recommendations are then returned to the committee to ensure compliance with the clinical recommendations.

Cost only becomes a concern in deciding whether to include a drug on a recommended formulary when there are a variety of therapeutic equivalents as determined by the pharmacy and therapeutics committee. In those cases, preference is given to the more economical of the therapeutically equivalent drugs. Wherever lower cost generic equivalent drugs are available, they are given precedence over brand drugs.