Drug Formulary and Tiered Co-payments
Your Rx drug benefit includes a list of medications called a formulary. A formulary is designed to provide you with high-quality prescription drug therapy while reducing costs. All medications have been reviewed by a Pharmacy and Therapeutics Committee based on safety, efficacy, uniqueness and cost. Coverage of any product is subject to your plan’s benefit design. If your plan has a three-tiered formulary benefit design, it has been constructed to assist and encourage
In general, a 3-tier benefit is designed as follows:
Tier 1: Generic Drugs - Generic drugs cost considerably less than their branded drugs. All are approved by the FDA as being equivalent in potency and purity to brand name counterparts. Your co-payment will usually be considerably less. Further, your health plan pays less for generic drugs.
Tier 2: Formulary Brand Name Drugs - These are preferred drugs selected by the Pharmacy and Therapeutics committee for your plan.
Tier 3: Non-Formulary Brand Name Drugs - These drugs are available, but at the highest co-payment. More cost-effective drugs usually exist in Tier 1 or Tier 2 for the same disease or condition.
At Northwest Pharmacy Services our formulary is developed and approved by an independent Pharmacy and Therapeutics Committee. When considering a drug for inclusion on the formulary, the decisions are based on specific criteria, which include:
• Efficacy • Safety • Uniqueness • Cost •
Medical and pharmacy experts research the medical literature for “best practices” and utilize evidence and value-based decision making to compare data that determines inclusion/exclusion to the formulary. Our formulary products are selected based on health outcome criteria. Cost is considered only after other criteria have been evaluated and is never a consideration if it compromises the quality of care.
We believe a well-managed formulary can have a positive effect on both patient outcomes and total medical care cost. Using flexible plan design, measurement and expertise, Northwest Pharmacy Services can develop the appropriate formulary for varying member populations helping our clients increase member satisfaction, improve outcomes, and reduce costs.