Managed formularies: Key considerations for plan sponsors

Conversations about managed formularies for private drug plans is garnering increased attention, yet implementation remains low. While a managed formulary could be key to striking the right balance between access to medications and cost management, plan sponsors may hold off due plan members’ perceived concerns. To help address these concerns, TELUS Health offers practical steps in the article entitled, “Managed formularies: Seeking more value from drug plans,” published as part of Benefits Canada’s Medication Management series.

Formulary design and ongoing communications are essential to facilitating implementation and engaging plan members. “A well-designed managed formulary always makes sure plan members have at least one covered option to treat the most common conditions,” states Jayson Gallant, pharmacist at TELUS Health. As well, a successful managed formulary always uses value, and not just cost, as the key driver for listing decisions. Clinical efficacy, safety and other factors such as impact on productivity contribute to the value equation.

Communications should start well in advance and not shy away from educating plan members about the growing challenges around drug-plan sustainability, and how a managed formulary helps everyone get better value from drug benefits. Insurance carriers can also communicate directly with members who will immediately be affected upon implementation of a managed formulary, based on claims data analysis.

As the cost of drug plans steadily grows, now is the time for plan sponsors to determine whether a managed formulary is a good fit. For an overview of key considerations, click here to download the TELUS Health article, “Managed formularies: Seeking more value from drug plans.”