To ensure the proper and cost-effective use of our home medical equipment, medical supplies and prescription medications, BLN manages healthcare product formularies for our clients. Our formularies emphasize the most cost-effective line of products within a given therapeutic class while maintaining high clinical standards. The formulary option chosen by the client becomes a benefit management tool used to educate providers, control program costs, and maintain quality care. Linking a clinically sound formulary with effective management options provides the following advantages:
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• Communicates a standard message of recommended therapeutic guidelines to participating physicians.
• Emphasizes consistent, cost-effective prescribing and dispensing behaviors; Ensures appropriate use of selected high risk and/or high cost products through the development of various treatment algorithms.
• Lessens the burden imposed on physicians by establishing recommended therapeutic guidelines
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Formulary Options
BLN provides its clients with a number of options for managing pharmacy benefit programs.
We offer five distinct formulary options:
These designs incorporate either 'Preferred or Mandatory' generic substitution options. Each formulary option uses the same drug formulary but differs in the level of restriction. BLN's formulary system has been in place and extremely successful since its inception in 1997.
Open Formulary
BLN's open formulary is entirely voluntary. Members are encouraged to ask their physician to prescribe formulary products. The open formulary is convenient for both the physician and member, placing no restriction on product selection. The purpose of an open formulary is to educate physicians and members on the most effective products.
Select Formulary
BLN's Select Formulary designates 'Preferred Products' within each product category. When therapeutic management programs are implemented as part of a formulary program, select therapeutic classes are 'restricted' while the remainder of the therapeutic classes within the formulary remain 'open' as in the open formulary described above. BLN targets product categories of particular importance to the client. After a thorough evaluation of a client's benefit history, BLN can recommend management of select product categories that incorporate BLN's formulary management strategies.
Prior Authorization
BLN can manage high cost or non-formulary products through its PA program. Our team of Care Coordinators and licensed pharmacists implements PA protocols. This highly trained staff of professionals is responsive to clients and physicians. As with other plan design options, we remain flexible in implementing PA programs.
Closed Formulary
BLN's closed formulary provides clients with maximum savings opportunities. Our clients typically save 10 to 25 percent in the first year of formulary closure. With BLN's closed formulary, all therapeutic classes in the formulary are closed as opposed to select classes in the option described above. Closed formulary benefits are the most cost-effective of BLN's products, as they ensure compliance with all plan cost containment strategies. Our closed formulary programs are coupled with a comprehensive physician and member education initiative to ensure program satisfaction.
Tiered Co-payment Formulary
In a three-tiered co-payment structure, members are charged a higher co- payment for non-formulary products. For example, co-payments may be established as follows:
| Formulary Preferred Product: |
$ 0 co-payment |
| Formulary Non-Preferred Product: |
$10 co-payment |
| Non-Formulary Product: |
$20 co-payment. |
A three-tiered co-payment structure encourages formulary compliance without denying the member coverage of non-formulary products.
Custom Formulary
We also administer population-specific formularies that are designed to accommodate the needs of a particular group.
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