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PCS TO LAUNCH "PREMIER Rx" FORMULARY-BASED DRUG BENEFIT PROGRAM

Executive Summary

PCS TO LAUNCH "PREMIER Rx" FORMULARY-BASED DRUG BENEFIT PROGRAM nationwide in April, the Scottsdale, Ariz.-based prescription claims management firm said. PCS' Premier Rx currently is being used by one client, the Maryland State Employee Benefit Program. Maryland's use of the benefit program began Jan. 1, and is being treated as a pilot project. PCS expects several HMOs to sign on with the nationwide launch. Maryland has been aggressive in its pursuit of formulary approaches for cost savings. Last year, the state disclosed plans to consider establishing a de facto formulary through extensive use of prior authorization under Medicaid. The 1990 Medicaid drug price rebate law prohibits states from establishing formularies that exclude drug products for which manufacturer rebates are offered to the state. Premier Rx does not cover drugs compounded in the pharmacy. It also excludes DESI products (those rated by FDA as not proven safe and effective) and experimental or investigational drugs. Although "physicians are encouraged to use the drug formulary when prescribing medication for plan members," PCS emphasized that "the formulary is not intended as a substitute for the knowledge, expertise, skill and judgment of prescribing physicians." However, the company urges pharmacists to "attempt to contact physicians when asked to fill a prescription for a nonformulary drug for which there are formulary alternatives." In addition, plan beneficiaries are required to pay higher co-payments for drug products not on the formulary but lower co-pays for generics on the list. PCS touts the program to benefit managers noting that some manufacturers will offer rebates to put their products on the formulary. Premier Rx was developed with Minnesota Blue Cross/Blue Shield and includes 1,100 drugs. The list was established by "an independent panel of physicians and pharmacists," who reviewed available products in each therapeutic class. A formulary committee meets quarterly to consider modifications to the list, and pharmacists who serve beneficiaries receive the list and quarterly updates. A second claims management firm, Perform, also based in Scottsdale, plans to launch a formulary-based program this spring. Perform's formulary service, DOCFormulary, is scheduled for a March 5 launch. It is a personal computer-based software program for use by physicians in managed care settings, the company said in a Feb. 20 announcement. Its purpose is "focusing physician attention on the efficacy, safety and cost effectiveness of pharmaceutical products." Perform was established in 1990 and is headed by former PCS President Thomas Field. Its first client was Arizona Blue Cross/Blue Shield ("The Pink Sheet" May 27, 1991, T&G-21).

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