Magazine article Drug Topics

What Drug Firms Need to Do to Get on HMO Formularies

Magazine article Drug Topics

What Drug Firms Need to Do to Get on HMO Formularies

Article excerpt

What do health maintenance organizations want from the pharmaceutical industry? Plenty, it turns out, and manufacturers--as well as pharmacy providers--aiming to do business with HMOs should understand exactly what will make an HMO haul out the welcome mat for them.

Begin the campaign to impress an HMO by knowing it thoroughly, said Burton I. Orland, director of pharmacy, Fallon Community Health Plan, Worcester, Mass. Find out if it's a group, staff, or independent practice type of organization and the types of medical specialists it includes. How many patients does it serve, and how many are on the "junior plan" versus Medicare?

What type of drug formulary does the HMO have, if any? How much is the prescription copayment or deductible? Does it do any drug studies? Does it have any research programs or hospital affiliations?

Who are the people you should see--the director of pharmacy, clinical pharmacist, P&T committee chairman, purchasing department, or all of these? What are their backgrounds, and who has the authority to sign on the dotted line?

For the benefit of manufacturers, Orland discussed the keys to adding their drugs to the HMO formulary. The marketer should be prepared to explain what makes its product unique, compared with what's currently available; it should also have available the drug's dosing regimen and dosing/strength comparisons with currently available drugs, as well as the side effects.

In addition, the manufacturer should be ready with literature on the drug for the clinical pharmacist to review, plus the opinion of the Medical Letter for the P&T committee to look over. …

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