Learned helplessness is a state of mind created when a person or group of people rely on something so heavily that they stop thinking critically for themselves. TransparentRx recently participated in a PBM finalist presentation for a self-funded employer and during the open discussion, I posed a question to their staff pharmacist who was part of the decision-making team.
Keep in mind this is a fairly large corporation with more than 5000 employees. I asked the pharmacist was there a reason why they didn't have a customized formulary? A representative from their third-party administrator (TPA) quickly chimed in and responded with, "we use the incumbent PBMs formulary but with edits."
I pushed back with, "
does it make sense that you allow a non-fiduciary PBM to control your formulary when it stands to benefit from how it is ultimately managed?" It is at this point when the pharmacist made a startling comment. The response to my question was, "we don't have a customized formulary because we don't have a P&T committee."
Here is the problem with that statement. No third-party payer requires an in-house P&T committee in order to take advantage of a customized formulary. There are reputable companies who specialize in formulary build-out and subsequent management of the formulary who may also maintain a P&T committee. Because these companies don't stand to benefit from any rebate dollars, their primary focus is drug efficacy, safety and cost-effectiveness not what's in it for them.
The decision to include a drug on a drug formulary is a process that considers such factors as efficacy, safety and cost-effectiveness. In managed health care plans, formularies are generally developed and maintained by a pharmacy and therapeutics (P&T) committee. The job of a P&T committee is to identify those products that are most medically appropriate and cost-effective. Overall, the P&T committee is tasked with determining what drug treatments best serve interests of a given patient population.