| In the current U.S. health-care system, the pharmacy | | | | may also help set guidelines for the patients' retail |
| benefit manager plays a vital role in helping contain | | | | cost of each drug. In many plans, consumers will pay |
| the cost of prescription drugs - both for consumers | | | | lower prescription co-pays for drugs that are on a |
| and for the health-insurance payers. One of the ways | | | | plan's formulary than for drugs that are not. And in a |
| in which benefit managers do this is by establishing | | | | few isolated cases, consumers may have to pay up |
| and managing a drug formulary for their clients. | | | | to 100% of the cost of a non-formulary drug. |
| A formulary is essentially a list of prescription drugs | | | | Although this may occasionally be costly for a small |
| that are covered by a given health-care plan, and to | | | | number of individuals, formularies do help keep the |
| what extent. The pharmacy benefit manager | | | | overall cost of prescription drugs down by |
| establishes the formulary by assessing the | | | | encouraging use of the most effective, least costly |
| effectiveness, safety, and cost of each drug for a | | | | drugs whenever possible. A skilled pharmacy benefit |
| wide range of medical conditions. Drugs that are | | | | manager will work diligently to ensure that formularies |
| highly efficacious and cost-effective are usually | | | | include at least one drug for each condition (or in |
| included in the formulary, while unproven or | | | | each drug class), and will encourage the greatest |
| disproportionately expensive drugs may be excluded. | | | | cost savings through the use of generic drugs, when |
| Once a formulary is established, the benefit manager | | | | appropriate. |