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Entering Formulary Information for Managed Care Business Plans

The Pharmacy Benefit view allows the managed-care account manager to see, in a view list, all the products in all the formularies associated with a given business plan.

To add PBM and formulary information to a business plan for a managed-care account

1. Navigate to the Business Plans screen, then the Business Plan List view.
2. Drill down on a business plan record.
3. Click the Pharmacy Benefit view tab.
4. In the Pharmacy Benefit list, create a new record, and complete the necessary fields.

   Some fields are described in the following table.

   Field	Comments
   Benefit Provider	Specify the account that owns the formularies that are relevant to the business plan. All products in all plans belonging to this account will be listed in the Formulary Status list in this Pharmacy Benefit view. Typically enter the name of the MCO account itself or of the PBM account. See note in Entering Health Plan and Formulary Information.
   Tiered Benefit %	Indicate the approximate percentage of lives belonging to health plans with a tiered pharmacy benefit.
   Open Benefit % Closed Benefit %	Indicate the approximate percentages of lives belonging to plans with open and closed formularies benefit.
   Reimbursement Policy	Enter information about the benefit provider's reimbursement policy that is relevant to the business plan, for example, the co-payment rates, premium increases, or recent policy changes.
   Formulary Approval Process	Enter information about the benefit provider's formulary approval that is relevant to the business plan, for example, how long it typically takes to have a new drug entered in the formulary.

5. Scroll down to the Formulary Status list and review the products in the formularies owned by the selected PBM.