Description and Analysis of the VA National Formulary (2000) / Chapter Skim
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Appendix B: Academy of Managed Care Pharmacy's Managed Care Formulary and Pharmacy Benefit Design Survey
Appendix B: Academy of Managed Care Pharmacy's Managed Care Formulary and Pharmacy Benefit Design Survey
Pages 227-230
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From page 227... ...
Physicians C Other Healthcare Professionals Exclusion of Coverage Regardless of the existence of a formulary or a system of nonformulary prior authorizations for exceptions, how many covered lives are enrolled in plans that exclude the following drug classes for reimbursement as a benefit design restriction: DESI drugs?
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From page 228... ...
Open-Preferred Formularies How many covered lives are in plans that have nonclosed formularies but have preferred classes, that is, classes in which there are drugs whose use is encouraged by incentives (lower copay, academic detailing, DUR, soft edits) , or usage criteria, or in which prescribing of nonpreferred drugs is discouraged.
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From page 229... ...
Generic Drugs Ilow many covered lives are in plans that require generic substitution? Access to Nonformulary Drugs How many covered lives fall under formulary systems which: Have a nonformulary exceptions process for coverage?
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From page 230... ...
Appeals Process now many covered lives are in plans that: have an internal appeals process for denials of drug coverage or reimbursement for excluded drugs? have an internal appeals process for denials of nonformulary drug requests?
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