Trying To Get Your Drug On a Managed Care Formulary?


To get your product on a managed care organization’s formulary, you need to convince the decision-makers the issue is not the price of the drug but why your product is more cost-effective in the long run.

Your product can only be cost-effective if it is taken correctly. For instance, patients who missed only 20% of their prescribed dose of beta-blockers for mild hypertension had a 4.5 to 6.5 fold increased risk of coronary heart disease.

This is why patient compliance is at the heart of your product’s long term success. It has been proven that high quality programs that teach patients how to take their medications result in lower healthcare costs:

  • An intensive one-week outpatient program of reevaluation and education of asthma patients produced a drop of 80% in hospitalizations, 45% in emergency room visits, and 82% in total hospital days within a year after the program.
  • Blue Cross/Blue Shield of Massachusetts realized a 50% drop in treatment costs and a 40% drop in hospital admissions when they combined an asthma education program with a 60% increase in the use of anti-inflammatory inhalers.