BluePeak understands the importance of formulary management in driving clinical and financial outcomes. Our multi-disciplinary team can design and manage formulary solutions that align with your organization’s unique goals.
Ways we can help
- Formulary Reviews
- Financial Analysis
- Utilization Management Criteria
- Prior Authorizations
- Step Therapy
- Quantity Limits
- Pharmacy and Therapeutics Committee Development and Delegation
- Clinical Analytics
Our pharmacists have experience leading teams responsible for formulary strategy across both the pharmacy and medical benefits in addition to chairing corporate P&T committees at health plans and hospital systems. These teams were responsible for developing the formulary and benefit design strategies, overall quality review of formularies developing the drug monographs utilizing primary, secondary and tertiary literature sources, development of prior authorization and step therapy criteria as well as transition policies and procedures.
To support the development and maintenance of the formulary, our pharmacists have the ability to create and present at P&T committees pharmacy coverage policies, clinical drug reviews, and therapeutic class reviews. Our pharmacists have also been responsible for monitoring the pipeline and making formulary placement recommendations in anticipation of market entry.
Creating, maintaining, and operationalizing utilization management edits is key to ensuring a cost-effective formulary. To that end, BluePeak consultants have experience with creating decision trees for P&T-approved prior authorization, step therapy, quantity limit and non-formulary criteria. Additionally, our pharmacists have experience not only with reviewing and decisioning prior authorizations/coverage determination and appeals/redetermination requests but have also successfully in-sourced the processes from vendors back to the plans themselves.
Finally, a strong clinical program is not complete without the financial analysis to accompany the clinical evaluation. BluePeak is very familiar with performance of these analysis and has skilled finance consultants as well as former rebate pharmaceutical manufacturer negotiation consultants that can assist with the financial analysis in order to determine the best financial outcomes when drugs are similar in nature.