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Principles of Formulary Management

Agenda. Formulary ScopeBaseline Formulary Inclusion CriteriaOngoing Formulary ManagementStakeholder Input Next Steps. 2. Goal of the Formulary. To create a rational, clinically appropriate, safe, and cost-effective drug formulary, for the Medicaid population. 3. . Medicaid Formulary Scope. 4. W

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Principles of Formulary Management

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    1. Principles of Formulary Management Donna L. Sullivan, Pharm.D., M.S. Special Assistant, Prescription Drug Program February 15, 2012

    2. Agenda Formulary Scope Baseline Formulary Inclusion Criteria Ongoing Formulary Management Stakeholder Input Next Steps 2

    3. Goal of the Formulary To create a rational, clinically appropriate, safe, and cost-effective drug formulary, for the Medicaid population 3

    4. Medicaid Formulary Scope 4 Wrap Around existing Preferred Drug List Number of classes depends on how you group drugs By condition when multiple drug classes treat same condition Pharmacological action when only one drug class treats a condition

    5. Baseline Formulary Inclusion Criteria For drug products where no product provides a significant clinically meaningful therapeutic advantage: Classes with both brands and generics Choose lowest cost generics Classes with only brands Choose lowest cost brand Examples 5

    6. Baseline Formulary Selection Example Antivirals 6 *ADC is derived from the average of published AWPs of all NDCs within the GPI and is used for illustrative purposes only. ADC does not reflect state maximum allowable costs for generic drugs, federal rebates or other discounts. This may result in distorted pricing and the relative cost between generic and brand drugs may not be accurately presented.

    7. Baseline Formulary Selection Example Antivirals Continued 7 *ADC is derived from the average of published AWPs of all NDCs within the GPI and is used for illustrative purposes only. ADC does not reflect state maximum allowable costs for generic drugs, federal rebates or other discounts. This may result in distorted pricing and the relative cost between generic and brand drugs may not be accurately presented.

    8. Baseline Formulary Selection Example Osteoporosis 8 *ADC is derived from the average of published AWPs of all NDCs within the GPI and is used for illustrative purposes only. ADC does not reflect state maximum allowable costs for generic drugs, federal rebates or other discounts. This may result in distorted pricing and the relative cost between generic and brand drugs may not be accurately presented.

    9. Baseline Formulary Selection Example Osteoporosis Continued 9 *ADC is derived from the average of published AWPs of all NDCs within the GPI and is used for illustrative purposes only. ADC does not reflect state maximum allowable costs for generic drugs, federal rebates or other discounts. This may result in distorted pricing and the relative cost between generic and brand drugs may not be accurately presented.

    10. Baseline Formulary Selection Example Hypertension Renin System 10 *ADC is derived from the average of published AWPs of all NDCs within the GPI and is used for illustrative purposes only. ADC does not reflect state maximum allowable costs for generic drugs, federal rebates or other discounts. This may result in distorted pricing and the relative cost between generic and brand drugs may not be accurately presented.

    11. Baseline Formulary Selection Example Hypertension Renin System Continued 11 *ADC is derived from the average of published AWPs of all NDCs within the GPI and is used for illustrative purposes only. ADC does not reflect state maximum allowable costs for generic drugs, federal rebates or other discounts. This may result in distorted pricing and the relative cost between generic and brand drugs may not be accurately presented.

    12. Baseline Formulary Selection Example Hematopoietic Drugs 12 *ADC is derived from the average of published AWPs of all NDCs within the GPI and is used for illustrative purposes only. ADC does not reflect state maximum allowable costs for generic drugs, federal rebates or other discounts. This may result in distorted pricing and the relative cost between generic and brand drugs may not be accurately presented.

    13. Baseline Formulary Selection Example Hematopoietic Drugs - Continued 13 *ADC is derived from the average of published AWPs of all NDCs within the GPI and is used for illustrative purposes only. ADC does not reflect state maximum allowable costs for generic drugs, federal rebates or other discounts. This may result in distorted pricing and the relative cost between generic and brand drugs may not be accurately presented.

    14. Baseline Formulary Selection Example Insulins 14 *ADC is derived from the average of published AWPs of all NDCs within the GPI and is used for illustrative purposes only. ADC does not reflect state maximum allowable costs for generic drugs, federal rebates or other discounts. This may result in distorted pricing and the relative cost between generic and brand drugs may not be accurately presented.

    15. Baseline Formulary Selection Example Insulins - Continued 15 *ADC is derived from the average of published AWPs of all NDCs within the GPI and is used for illustrative purposes only. ADC does not reflect state maximum allowable costs for generic drugs, federal rebates or other discounts. This may result in distorted pricing and the relative cost between generic and brand drugs may not be accurately presented.

    16. Ongoing Formulary Management How are new products incorporated into the formulary? New Chemical Entity New Generic New Formulation New Indications How often do we implement changes to the formulary? 16

    17. Next Steps March 15, 2012 DUR Board Meeting 17

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