Effect of a Restrictive Formulary on Prescription Cost
Effect of a Restrictive Formulary on Prescription Cost
Q: To continue providing medications to its members, a federally qualified health center requested our assistance in redesigning the prescription benefit. What approach might work best for this type of organization?
A: The Omnibus Budget Recon-ciliation acts of 1989 and 1990 designated federally qualified health centers as a unique type of health care provider that serves uninsured individuals who, although not eligible for Medicare or Medicaid, have a hard time obtaining primary care because of economic or geographic barriers. These "safety-net" providers are not required to provide coverage for medication through a prescription benefit. One such facility, a community health center in New York City, considered the prescription benefit to be a critical part of the services it provided. So, when an increase in the average cost per prescription was noted over three successive quarters and the center's ability to provide this benefit was jeopardized, Centrus Pharmacy Solutions, a pharmacy benefit management company (PBM), was asked to develop and implement a clinically valid, highly restrictive formulary to help reduce these costs.
Q: To continue providing medications to its members, a federally qualified health center requested our assistance in redesigning the prescription benefit. What approach might work best for this type of organization?
A: The Omnibus Budget Recon-ciliation acts of 1989 and 1990 designated federally qualified health centers as a unique type of health care provider that serves uninsured individuals who, although not eligible for Medicare or Medicaid, have a hard time obtaining primary care because of economic or geographic barriers. These "safety-net" providers are not required to provide coverage for medication through a prescription benefit. One such facility, a community health center in New York City, considered the prescription benefit to be a critical part of the services it provided. So, when an increase in the average cost per prescription was noted over three successive quarters and the center's ability to provide this benefit was jeopardized, Centrus Pharmacy Solutions, a pharmacy benefit management company (PBM), was asked to develop and implement a clinically valid, highly restrictive formulary to help reduce these costs.
