September 28, 2017

Will COVID-19 Impact 2021 Commercial Formulary Decisions?

I’m Charline Shan, Vice President, Director, Access Experience Team, editor of All Access, I hope to bring you noteworthy and groundbreaking news to Precision Value and Health’s bimonthly newsletter by sharing the latest payer insights brought to you by our team of former access decision-makers.

As summer begins and states slowly begin to lift restrictions due to COVID-19, payers enter into their 2021 Commercial formulary strategy planning season. Faced with unpredicted demand, costs, and losses, payers are evaluating the impact and assessing their next move. Do payers stay the course and continue to drive more products to exclusion lists? Or do they deviate from this path and allow for less restrictions? A lot of uncertainty remains, so in in this issue, we offer perceptions and responses by payer type and the necessary next steps for market access stakeholders. Todd Edgar identifies the likely strategy of PBMs, Andy Cournoyer discusses the viewpoint of a national health plan, Erin Lopata reviews the response from a regional health plan, and Avi Mamdi examines the impact of commercial payers’ strategies to health systems and IDNs.

I think you’ll find the insights in All Access 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.

Stay safe and be well,

Charline Shan, RPh, MPH
Vice President, Director
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 PRECISIONvalue.

Guest Editor
Charline Shan

Executive Editor
Louis Landon

Andrew Cournoyer
Ryan Cox
Dan Danielson
Todd Edgar
Dominic Galante
Ami Gopalan
Joe Honcz
Louis Landon
Erin Lopata
Avi Mamidi
Reta Mourad
Elizabeth Oyekan
Kellie Rademacher
Jeremy Schafer

2021 PBM Commercial Formulary Exclusions Are Here to Stay Even With COVID-19

The trend in the approach to formulary management is to become more restrictive every year. This year is an exception, with some industry restrictions loosening in response to the COVID-19 pandemic. As the formulary development process for 2021 begins, Todd Edgar discusses whether the historical trend will continue or if there will be more efforts to loosen restrictions.

How COVID-19 May Shape the 2021 Commercial Formulary Strategy for a National Health Plan

While 2020 first quarter earnings fell short for many companies and industries, many national health insurers actually exceeded initial expectations. A common theme in each of these cases was that the PBM was cited as the driver of growth. Andrew Cournoyer discusses the viewpoint of a national health plan with an eye on maintaining positive adaptations in a COVID-19 world.

Regional Health Plans: COVID-19 and 2021 Commercial Formulary Decisions

As the country continues to battle COVID-19, regional health plans are beginning to shift focus from pandemic response to 2021 formulary planning. While they will continue to adapt, there will undoubtedly be lasting downstream impacts and challenges from COVID-19. Erin Lopata discusses the response expected for regional health plans.

How Will Commercial Payers’ Management of 2021 Formularies Impact IDNs and Health Systems?

Throughout the healthcare landscape, there is continued adaptation in practice management in response to COVID-19. Commercial payers are changing the way they manage their 2021 formularies, but what about the ripple effects? Precision’s Avi Mamidi discusses how these changes will impact integrated delivery networks and health systems.