2020 Formulary Predictions: Get Ahead of the Latest Changes
The months of September and October are filled with anticipation as 2020 commercial and Medicare formularies are revealed. Will the various legislative attempts and successes influence 2020 formulary decisions? Does public outcry of high drug prices and out-of-pocket costs carry weight when managing drug spend is a priority for decision makers? These questions come to mind as we try to surmise whether any formulary surprises are in store for 2020. Todd Edgar assesses how PBMs may react to the current legislative environment; Dan Danielson examines how PBMs influence regional health plans’ 2020 decisions; Elizabeth Oyekan shares the pressure points that influence IDNs and formulary possibilities; and Andrew Cournoyer discusses anticipated Medicare 2020 formulary changes.
I think you’ll find the insights in All Access to be thought provoking and helpful in navigating the payer landscape. As always, please feel free to drop me a note and let me know if you have a topic suggestion for the payer team to address, and we’ll do our best to cover it in a future edition.
Charline Shan, RPh, MPH
Vice President, Access Experience Team
All Access is a bimonthly newsletter that features key insights from our team of former payers, intended specifically for market access leaders. It is published by Precision for Value.
Rebate sharing, exclusion lists, and application of QALY measures are all approaches that PBMs are likely to ramp up in 2020, predicts Todd Edgar. Todd examines the impact of new formulary guidelines and makes some predictions on other trends likely in the coming year.
Dan Danielson examines the incentives for regional plans offering exclusion formularies, and how the next iteration of exclusions is designed to keep plans competitive and relevant in an environment rich with acquisitions and mergers.
What are the key considerations and emerging trends for IDNs as they work with their plans on 2020 formulary decision-making and selections? Elizabeth Oyekan breaks this down and focuses on the pressure points.
Andrew Cournoyer outlines recent Medicare regulatory changes likely to influence formulary offerings and emphasizes the trend toward patient affordability and drug pricing in 2020 formulary design.