WorkCompWire – an online news service focused on workers’ comp – recently featured Healthesystems’ Britten Featherston, PharmD, Manager of Clinical Services, in an article on driving more personalized care through strategic formulary design.
In today’s evolving workers’ compensation landscape, the shift toward more personalized, outcomes-driven care is not just aspirational – it’s essential. That’s because injured worker patients are not one-dimensional – they are nuanced, living, breathing beings with complex characteristics and needs. For Pharmacy Benefit Managers (PBMs), formulary design and management are powerful levers to drive toward more personalized care for these patients.
An effective formulary strategy is not a set-it-and-forget-it approach. Just as each injured worker is a three-dimensional being living in a dynamic environment, your formulary design should be agile, too. Nimbleness, in addition to configurability, is crucial to keeping up with changing regulations, emerging therapies, evolving prescribing behaviors and workers’ comp populations, and payer needs.
Many factors come into play to determine what medication and dosage is appropriate for each injured worker: those inherent to injury type or occupation, injured worker-specific factors such as age, safety factors, and more – and some of these factors continue to evolve over time. Evidence-based medicine, too, is always evolving, and your formularies should evolve right along with it to ensure alignment with the latest therapeutic guidance.
The beauty of strategic formulary design is that we can take all of the factors we mentioned into account and implement formularies that are personalized to meet the three-dimensional needs of every injured worker. By partnering with a PBM that offers this multi-layered capability, payers can ensure each injured worker receives the most appropriate and safe drug therapies – and provide better outcomes for all.
The Complexities of Formulary Management
It’s no secret that formulary management, at its very core, is complex. At the bare minimum, PBMs must account for state-specific formularies and changing regulations – and that’s before layering in injured worker-specific factors and unique therapeutic needs, many of which will vary depending on a payer’s covered population.
“PBMs must have deep regulatory and clinical expertise – as well as an intimate understanding of their customers – in order to design the most informed formularies for their clients,” explained Britten Featherston, Healthesystems Manager of Clinical Services…
