Stay well ahead with a different kind of PBM.

Formulary Management

Catamaran 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.


Our 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.


Once P&T 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.



Value Formulary

The Value 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 effectiveness.


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 offerings:



Advantage Formulary

The Advantage 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.



National Formulary

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

The 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 D, Workers’ 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

Catamaran’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 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.