Formulary and Rebates
PDMI provides our clients with formulary management expertise that focuses on balancing the most appropriate drug options with a full pass-through rebate model. We meet our clients' objectives with standard formularies that range from very narrow evidence-based to more broad open formularies. Regardless of the formulary type, we closely monitor the drug pipeline to ensure the drug lists of our clients are always up-to-date.
Critical components of PDMI's formulary management program include:
1. Pharmacy and Therapeutics (P&T) Committee management
Ensuring the decisions pertaining to our formularies are the most appropriate ones based on sound clinical and financial evidence.
2. Clinical drug reviews and updates
We maintain a watchful eye on the pharmaceutical industry's drug pipeline. Benefit design recommendations for new medications depend entirely on the clinical comparability of the new drug to others within the same class, as well as economic factors.
3. Preferred drug list development
Where a multi-tiered copay structure exists, and there is a real opportunity to influence the utilization of preferred drugs, we offer a highly managed formulary that features the most cost effective products. This approach seeks balance so reasonable rebates are achieved – but not at the expense of the net payer ingredient cost. We also have the ability to create formularies for our clients that have as many tier levels as fit their plan objectives.
Pharmaceutical contracting and administration
We ensure that your rebates are aligned with your goal of high-quality, cost effective benefit management. Our services include:
1. Performing accurate and timely billing as well as collecting rebates from pharmaceutical manufacturers.
2. Providing detailed analysis regarding formulary performance and contracting to meet the program's predetermined goals. (Based on this analysis, we identify areas of performance requiring improvement and suggest suitable responses.)
Your organization's interests are our foremost focus …
PDMI maintains its independence from pharmaceutical manufacturers, wholesalers, chain pharmacies and large insurance companies. This autonomy assures our clients that their interests are our interests as we implement customized programs to meet both their short- and long-term objectives.
