Formulary Optimizer

Rising co-payments and restricting drug access are strategies used by Medicaid and commercial payers to reduce expenses and increase profitability.

However, these strategies negatively impact physicians' ability to prescribe what's in the best health interests of their patients.

Our Formulary Optimizer brings together physicians, patients, industry and advocates to demand that government bureaucracies, health insurance plans, and call center personnel not make decisions best left to doctors about treatments for patients.

As a senior managed care executive of a leading US Biopharmaceutical told us when deciding to employ our strategy: "P&T committee members aren't used to having patients call or e-mail to pressure them. They hate it."

Why do they hate it? Because we shine a public light on the decisions they are making and their attempt to play doctor with patients' health.

case study.

the challenge.

Placement on any particular formulary dictate the revenue stream for the drug – lower tiers are preferred; higher tiers, steps, and prior authorizations are to be avoided. However, what arsenal does a pharmaceutical have against a commercial payor threatening to "replace" the drug with a "therapeutic equivalent"? After all, complaining will be seen as self-serving, both by the payor and public.

the solution.

The battleground was shifted to a playing field that the payor couldn't win on -- patient access and physicians' right to practice medicine in the best interests of their patient.

Patients, physicians and advocates were mobilized to contact key decision makers, and meetings were established to "assist" the payor in finding an acceptable public resolution.

the result.

Formulary status maintained.

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