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Formulary Management Unique to Each Client

A clinically sound and cost-effective drug formulary is the cornerstone of a health plan's cost and utilization management strategy. When it comes to your formulary, PerformRx works collaboratively with our customers to provide recommendations to enhance both clinical outcomes and financial performance pertaining to your formulary.

All health plans have unique formulary needs, such as patient populations and demographics, which may require modification to meet the plan’s specific goals. PerformRx has significant experience in developing client-specific open, closed, and tiered formularies and working to increase generic drug utilization.

PerformRx's Formulary Management department includes a team of clinical pharmacists assigned to a customer's formulary. These experienced pharmacists will continually monitor the pharmaceutical pipeline, member drug utilization, standard of care guidelines, and biopharmaceutical sources to identify cost savings opportunities. In addition to our Formulary Management department, PerformRx has a team of pharmacoeconomists and outcomes researchers. This team suggests new or revised utilization protocols to ensure that decisions are made from a clinical, humanistic, and pharmacoeconomic perspective.

As needed, proposed formulary changes are sent to likely prescribers of the affected medications to achieve their support. This process helps to ensure that any utilization management policy is clinically sound and any issues that the reviewers find are addressed prior to implementation.

On average, PerformRx's formulary compliance rate is 98.7 percent across our book of business. We promote formulary compliance through our extensive point-of-sale edits and prior authorization system.