offers comprehensive formulary management services that include a wide range of
options, from our standard Value Formulary through to our support of custom
formularies. Our options give our clients the flexibility to choose how tightly
they want to manage their formularies. In all cases, Catamaran brings a
rigorous, evidence-driven approach to formulary development and management.
independent Pharmacy and Therapeutics (P&T) Committee develops and
maintains our formularies. The multi-disciplinary committee brings an unmatched
level of clinical expertise and experience to the process. The P&T Committee
leverages best practice guidelines and physician expertise to comparatively
review and appraise medication efficacy and safety—and to make determinations
regarding formulary status. The committee proceedings do not include any
discussion of drug costs so as to not bias clinical determinations.
deliberations are complete, an internal Business Review Committee determines
final formulary status for each drug based on the clinical designations
assigned by the P&T Committee, projected financial impact, member and
physician disruption and generic availability.
Formulary, our standard formulary option, delivers substantial savings to
clients. It maximizes the utilization of generics and preferred brands while
reinforcing clinically-sound, yet cost-effective drug choices by members.
Specifically, the Value Formulary excludes coverage of approximately 140
brand-name drugs that do not offer a clear clinical advantage over other
less-costly brand or generic alternatives. New
products to the drug marketplace are automatically excluded from the Value
Formulary until they have been fully reviewed for clinical and cost
Catamaran offers formulary options
beyond the Value Formulary. To help clients select a formulary that meets their
needs, our formulary strategy team can analyze the impact of our various
Formulary drives savings through the combined use of utilization management
edits and a reduced number of preferred brands. This formulary is designed for clients who prefer a more tightly managed
formulary paired with utilization management services, such as step therapy,
prior authorization and quantity limits.
The National Formulary
offers the greatest breadth of brand and generic drug options, and uses a
three-tier copay structure with generics in Tier One, preferred brands in Tier
Two and non-preferred brands in Tier Three. The National Formulary provides access to a broad range of drug
therapies across multiple therapeutic categories with a focus on generic
options where clinically appropriate. Rebate performance is maximized, while
costs are controlled via appropriate benefit design and DAW penalties to drive
to higher use of generics and preferred products.
Generic-Centric Formulary is our most cost-effective offering that limits
preferred formulary options to primarily generic drugs. In classes where there
are few, if any, clinically-sound generics, the formulary is supplemented with
preferred brand drugs. Non-preferred drugs are excluded.
Essential Health Benefits Formulary
In support of clients
participating in Health Insurance Marketplaces (formerly known as Health Insurance
Exchanges), Catamaran provides our Catamaran Essential Health Benefits (EHB)
Formulary. This formulary is designed to meet the EHB requirements across all
50 States and the District of Columbia.
Custom Formulary Development & Management
Catamaran offers turn-key
custom formulary development and management. Our Clinical Team has extensive
experience and expertise in the support and management of custom formulary
operations across all market sectors, including Commercial, Medicaid, Medicare Part
Compensation and more. All formulary experts are clinical
pharmacists with more than five years of PBM/managed care experience.
Access Catamaran’s formulary options.
Drug Utilization Management
utilization management (UM) programs are designed to improve formulary adoption
and promote cost-effective treatment options. All drug utilization management strategies
are developed by clinical pharmacists specifically trained in development of
evidence-based UM, and vetted by the P&T Committee as well as external
physician experts in the appropriate field of expertise. Catamaran offers a
range of UM strategies including prior authorization, step and contingent
therapy, and quantity/dosing limitations. Once again, Catamaran offers the
flexibility of delivering both standard UM programs as well as supporting
clients in the development and maintenance of custom UM protocols.
Drug Pipeline Monitoring & Reporting
Catamaran closely monitors
and evaluates drug products even before they hit the market in order to provide
our clients with the most proactive information and advice to manage their
pharmacy program. See our Insights section for more information about our drug
pipeline reports, including our clinical publications RxOutlook and RxHighlights.