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Managed Markets: Formularies

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Product Description

Biologics and injectable medications are coming under increased scrutiny by managed care organizations (MCOs). MCOs, pharmacy benefit management companies (PBMs), and other payers are beginning to apply cost-management strategies to high-cost biologic, injectable medications, and specialty drugs. They are using distribution networks to capitalize on lower pricing and rebates from manufacturers.
They also are implementing cost-sharing arrangements with members. In 2005, 74% of workers with employer-sponsored coverage had a cost-sharing arrangement with three or four tiers, compared with 27% in 2000, according to the Henry J. Kaiser Family Foundation’s June 2006 report…

Sidebars:
Payers’ Strategies for Managing Specialty Products

Experts on this topic
Kevin Barnett. Senior VP, Managed Markets Practice, Campbell Alliance, Raleigh, N.C.; Campbell Alliance is a specialized management consulting firm serving the pharmaceutical and biotech industries. For more information, visit campbellalliance.com.
John Carlsen. Principal, Consulting Services, Covance Market Access Services, Covance Inc., Princeton, N.J.; Covance is a drug-development services company offering solutions from preclinical to commercialization. For more information, visit covance.com.
Michael Dezelan. Senior VP, Managed Markets, Serono Inc., Rockland, Mass.; Serono Inc., the U.S. affiliate of Serono SA, a global biotechnology leader in Geneva, is committed to discovering and developing innovative products that address unmet medical needs. For more information, visit seronousa.com.
Tom Koenig. Senior Director, Segment Marketing, Endo Pharmaceuticals, Chadds Ford, Pa.; Endo is a specialty pharmaceutical company with a focus on pain management. For more information, visit endo.com.

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