Last Updated: Aug 13, 2018
Every health insurance carrier in Pennsylvania uses different drug formulary criteria. Why is that?
The Academy of Managed Care Pharmacy (AMCP) says that “due to the multiplicity of medications on the market and the continuous introduction of new medications, a formulary must be a dynamic and continually revised listing.”
Essentially, drug formularies are like moving targets to office administrators and physicians. Not only do payers use different criteria, but those criteria can also change several times a year. A medication that a patient needs can be on the formulary one day but gone the next. This can be frustrating.
The process needs to be reformed because it negatively impacts patient care and lacks transparency, standardization, and consistency.
The Government Relations Team at the Pennsylvania Medical Society (PAMED) is working to engage lawmakers on the topic with the goal of getting legislation introduced to fix the process. In the meantime, here are the top 4 ways to access drug formulary information to make the process less stressful:
- Use an all payer portal, like NaviNet, that connects insurers and physicians in one online location to ease the process of understanding the prescription drug tiered system.
- Configure the EMR system in your office to make drug formulary information more accessible at the time of prescribing.
- Create short cuts on office computers to directly connect to payer portals online.
- If all else fails, call the insurer to request specific details related to the latest drug formulary.
The need for a more standardized process for drug formularies is one of PAMED’s legislative priorities for 2018. For information on all of PAMED’s legislative priority issues, visit www.pamedsoc.org/advocacy.