Catamaran offers a comprehensive set of Formulary Management services that include a wide range of options, from standard formularies to service and support for 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. Our independent 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. Once P&T deliberations are complete, an internal Business Review Committee then 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.
Standard National Formularies
In an effort to deliver flexibility in formulary programming with the reliability of sound, evidence-driven drug selection, Catamaran offers three standard national formulary options. The Catamaran 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.
Formulary Advantage ProgramFor those seeking a more aggressively managed formulary program, Catamaran offers its Formulary Advantage Program to further drive generic utilization and preferred brand compliance leading to lower net cost. The program 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. Access the Formulary Advantage Program.
Essential Health Benefits FormularyIn support of clients participating in Health Insurance Marketplaces (formerly known as Health Insurance Exchanges), Catamaran also provides our Catamaran Essential Health Benefits (EHB) Formulary. Based largely off of our Advantage Formulary, this Formulary is designed to meet the EHB requirements across all 50 States and the District of Columbia. Access the Essential Health Benefits Formulary.
Custom Formulary Development & ManagementIn addition to standard formulary options, 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 D, Workers’ Compensation and more. All formulary experts are clinical pharmacists with more than five years of PBM/managed care experience.
Drug Utilization ManagementCatamaran’s drug 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 all are vetted by our Catamaran National 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 & ReportingCatamaran 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.