Best Practices in Formulary Success: Key Payer Responsibilities and the Information & Qualities they Seek from Field Medical Teams

Industries Profiled:
Health Care; Insurance; Medical


Companies Profiled:
Aetna; Anthem; Ascension; Cleveland Clinic; CVS Health; DaVita; Express Scripts; Inc.; HCA; Humana; Kaiser Permanente; MedImpact; St. Joseph's Health; Tenet Healthcare ; UnityPoint Health; University Hospitals; WellSpan Health

Study Snapshot

Best Practices, LLC engaged 23 formulary leaders from 16 Managed Care Organizations through a benchmarking survey. Five formulary leaders participated in deep-dive interviews.

Key topics covered in this report include:

• Primary activities
• Key information or data used
• How information or data is used and why it is useful
• Interaction level with FMT members from 11 pharmaceutical companies
• Primary topics discussed in FMT interactions
• Rating of FMTs from 11 pharmaceutical companies

• Comparative Data on Efficacy & Safety Holds Sway in Formulary Decisions

• Information on efficacy/safety is still considered the gold standard for assessing new products.
• When FMTs can provide comparative information on these key product attributes, they are fast-tracking payers’ formulary decisions. When pharma does not provide this information, payers develop their own comparative data.

I.	Executive Summary	pp. 5-12
	Study Overview	p. 5
	Methodology	p. 6
	Participant Demographics	p. 7-9
	Key Findings	p. 10-11
	Recommendations	p. 12
II.	Primary Responsibilities of Respondents	pp. 13-24
III.	Information Used for Formulary Decisions – How is it Used and How is it Useful?	pp. 25-65
	Overview of Top 10 Information Types	p. 26
	Safety and Efficacy	p. 31-33
	Clinical Practice Guidelines	p. 34-35
	Comparative Data	p. 36-38
	Meta-Analyses	p. 39
	Compendia	p. 40
	Health Technology Assessments	p. 41
	FDA Approval Data	p. 42
	Clinical Pathways	p. 43-44
	Product Pricing Analysis	p. 45-46
	Managed Care Trends	p. 47
	Budget Impact Models	p. 48-49
	Real World Evidence	p. 50-51
	Pipeline and Pre-launch Product Updates	p. 52-53
	Quality of Life/PRO Data	p. 54-55
	Healthcare Economic Information	p. 56-57
	Research Program Support for Trials	p. 58
	AMCP Dossiers	p. 59-60
	Information for Evaluating Biosimilars	p. 61
	Patient Support Programs	p. 62-63
	Value Frameworks	p. 64
	Disease Education	p. 65
IV.	Voice of the Customer: The Good, Bad and Ugly of FMT Interactions	pp. 66-72
V.	Field Medical Team Interactions: Frequency and Value Metrics for 11 Pharma Companies	pp. 73-97

• Top two activities that constitute the primary responsibilities of payers and interview narratives explaining how pharma helps support these activities
• Time spent on key listed activities
• Key responsibilities of MCOs and PBMs
• Time spent on reviewing clinical data and making recommendations; and the role of pharma companies in helping payers in conducting these activities
• Time spent on developing formulary policy decisions; and the role of pharma companies in helping payers in conducting these activities
• Time spent on ensuring compliance with healthcare delivery programs; and the role of pharma companies in helping payers in conducting these activities
• Time spent on developing or implementing pathway decisions; and the role of pharma companies in helping payers in conducting these activities
• Time spent on modifying programs due to changes in law (federal or state); and the role of pharma companies in helping payers in conducting these activities
• Time spent on reviewing healthcare economic data and making recommendations; and the role of pharma companies in helping payers in conducting these activities
• Time spent on performing healthcare economic analysis; and the role of pharma companies in helping payers in conducting these activities
• Time spent on other key activities; and the role of pharma companies in helping payers in conducting these activities

• Top 10 information types, importance rank, usage and importance
• Importance of information provided by outside sources for formulary decisions
• Usage vs. Importance of different information types
• Importance of different information types for MCOs and PBMs
• Importance of product efficacy/safety information and how this information is used
• Pharmacy director at a medium managed care organization shares his viewpoint on product efficacy and safety
• Pharmacy director at a large managed care organization shares his perspective on product efficacy and safety
• Importance of clinical practice guidelines and how this information is used
• Benchmark partners’ narrative on clinical practice guidelines
• Importance of comparative data and differentiating factors, and how this information is used
• Benchmark partners’ narrative on comparative data
• Perspective of pharmacy director from a large managed care organization on comparative data
• Importance of meta-analyses or systematic reviews and how this information is used
• Importance of compendia and how this information is used
• Importance of published health technology assessments and how this information is used
• Importance of FDA approval data and how this information is used
• Importance of clinical pathways information and how this information is used
• Interview narrative of a senior manager from a PBM organization on why clinical practice guidelines are more important to them than clinical pathways information
• Importance of product pricing analysis and how this information is used
• Benchmark partners’ perspective on the impact of pricing on product comparisons
• Importance of managed care trends and how this information is used
• Importance of budget impact models and how this information is used
• Pharmacy director at a medium managed care organization talks of the nuances of using economic data
• Importance of real world evidence and claims data, and how this information is used
• Pharmacy director at a large managed care organization shares his perspective on the importance and use of real world evidence and claims data
• Importance of pipeline and pre-launch product updates, and how this information is used
• Pharmacy director at a large managed care organization gives recommendations for pharma companies to improve interactions with managed care
• Importance of quality of life/patient reported outcomes data, and how this information is used
• Benchmark partners’ viewpoint on the various parameters considered for approval of new products
• Importance of healthcare economic data and how this information is used
• Pharmacy director at a large managed care organization shares whether MCOs consider pharma organizations’ pharmacoeconomic analysis trustworthy or not
• Importance of research program support for trials and how this information is used
• Importance of AMCP dossiers and how this information is used
• Senior manager at a PBM organization shares the importance of ACMP dossiers
• Importance of information for evaluating biosimilars and how this information is used
• Importance of information received from patient programs and how this information is used
• Pharmacy director at a medium managed care organization shares the importance of patient programs
• Importance of value frameworks and how this information is used
• Importance of disease education and how this information is used

• Benchmark partners shared what they liked about their interactions with field medical teams form pharma organizations
• Benchmark partners shared the reasons for low rankings given to certain pharma companies in terms of their FMT interactions
• Benchmark partners shared their pet peeves regarding FMT visits
• Benchmark partners’ perspective on where pharma is falling with the information they provide
• Benchmark partners share the kind of information that is important for decision-making in the oncology therapeutic area
• Senior manager at a PBM organization mentions the differences between informational needs of MCOs and PBMs

• Payer ratings of field medical teams at listed pharma companies
• Frequency of personal interactions with any medical field representative from the eleven mentioned companies, and the primary topics discussed during these interaction(s)
• Quality rating of field medical interaction(s) from the eleven mentioned companies on a 5-point scale, and the reasons for the given rating
• Ideal traits of field medical representatives