Driving Drug Savings Through Formularies
Industry-leading formularies = greater value
With more than 19,000 approved prescription drugs available in the U.S., formularies are lists of covered medications to help guide clients and customers to clinically sound, cost-effective medications. Formularies help ensure access to the most effective medications, drive competition among pharmaceutical companies, and help combat an estimated $16 billion wasted every year on low-value medications.
How we build well-designed formularies
Express Scripts builds formularies, or lists of covered medications, to provide clients with the most clinically sound, high-quality pharmaceutical products, which are updated as new medications come to market. Our clients can select a formulary that is most appropriate for their unique member needs, customize any formulary or develop their own. Express Scripts’ formulary development process is based on three principles:
Clinical appropriateness, safety and effectiveness of the drug — not cost — are the foremost considerations.
The prescribing physician always makes the final decision regarding their patient’s drug therapy.
Express Scripts develops clinically-sound formularies based on evaluations of independent physicians.
Consistent with these principles, Express Scripts offers a variety of standard formularies, which are developed through a four-step process involving the work of distinct committees:
- Therapeutic Assessment Committee (“TAC”);
- National Pharmacy & Therapeutics (“P&T”) Committee;
- Value Assessment Committee (“VAC”); and
- An annual formulary review by the National P&T Committee.
The TAC and P&T Committee – which have no access to cost or financial information – have first and last word on formulary recommendations.
Every drug is given one of four designations, which will result in placement on or exclusion from Express Scripts formularies:
Recommended for inclusion on all Express Scripts National Formularies.
Formulary recommendations should be based on a value assessment by Express Scripts.
Drugs in this category should not be added.
Recommended for conditions where there is only one drug available – typically this includes a relatively small number of patients.
Express Scripts clients have secured cumulative savings of approximately $30 billion since 2014 from our formulary selections and strategies.1
A look at key Express Scripts formularies
Express Scripts’ largest standard formulary, the National Preferred Formulary (NPF), includes about 600 brand-name drugs and 99% of all generics. Based on the formulary review process, excluded drugs are less effective or safe than existing therapies – or lack sufficient clinical evidence for inclusion on Express Scripts formularies.
These exclusions account for a tiny percentage – about 3% of FDA-approved drugs were excluded in 20232 – and enable Express Scripts to drive greater competition among pharmaceutical manufacturers and greater savings for clients who can pass those savings to patients.
A majority of Express Scripts clients design custom formularies based on their unique patient population.
Read more about how medicines are priced