Tier and Formulary: How to Achieve Better Results

Medications on a formulary are often selected by a panel of experts. These experts are typically independent of a patient’s insurance company and are often referred to as a pharmacy and therapeutics committee. The panel often includes nurses, pharmacists and doctors along with other clinical experts, says the Nerd Wallet.

How drug formularies work

These are often made up of lists of drugs that a health insurance provider has consented to pay for its policy owners. The list is rife with complications, though, especially since patients will need to undergo a time-consuming process to determine which drugs are ideal for their conditions. Often, these drugs are not the first ones that a doctor might prescribe for their patients.

Formulary groups

Formularies are often divided into two to five groups. The division relies on price differences and the groups are called tiers. Each tier will be associated with a copay. A copay refers to the flat rate you shell out for a drug at a pharmacy.

Working with a formulary

If you run the pharmacy, one of the first things you will need to do to improve ROI and the bottom line is to adjust your tier and formulary status regularly. Be responsive to changes in the market. Start by hiring the services of a market research team. By engaging the team’s services for business intelligence and insights, you have a clear understanding of what’s happening in the market. That’s going to help you refine and tweak your tier and formulary status to ensure it’s up to date and well-aligned with market changes.

Finding help

Look for a market research company you trust. Ask around. Reach out to your network and ask tips and referrals from professional contacts. These steps can help you find a trustworthy and reliable firm to provide the data you need.