Chief Science Policy Officer, Global Healthy Living Foundation, Upper Nyack NY; Senior Health Policy Fellow, Progressive Policy Institute, Washington DC; and Visting Health Policy Fellow, Pioneer Institute, Boston, MA, United States of America
Research Article
Analysis of Drug Formulary Exclusions from the Patient's Perspective: 2023 Update
Author(s): Sara Chea, Anne M. Sydor and Robert Popovian*
Objective: Pharmacy Benefit Management companies (PBMs) often determine medication reimbursement, out of pocket costs, and access through formularies. Formularies were initially intended to ensure the use of cost-effective medication. Today, formularies are designed to maximize concessions (i.e., rebates, discounts, or fees) to PBMs from the biopharmaceutical industry. Formulary exclusions enhance the ability to drive profits through rebate contracting for PBMs. Our 2022 research analyzed whether formulary exclusions benefit patients medically or economically. This update provides an analysis of exclusions based on the 2023 Express Scripts (ESI) national formulary.
Methods: We analyzed ESI’s 2023 national preferred formulary exclusions. ESI is the second-largest PBM in the U.S. and makes its national preferred formulary exclusions list.. View More»
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