Providing choice and flexibility, while ensuring access and affordability for patients.

A formulary is the list of prescription drugs covered by a health insurance plan or employer that is made available to a patient under their prescription drug benefit. The pharmaceutical market is dynamic and fast-changing, so one of the important roles of health plans is managing formularies to make sure patients have access to safe, effective treatments they need while providing patients the most affordable drug options.  

Evernorth and Express Scripts specialize in creating drug formularies for thousands of health plans and businesses, and this continuous process is always driven first and foremost by clinical factors. The financial impact to our company is expressly excluded and prohibited from consideration in the formulary development process.

Formularies are an important tool to reduce costs while preserving patient choice. This can be done by providing incentives for patients to choose lower-cost, clinically equivalent drugs such as generics, or excluding so called “me too” drugs that lack added clinical benefit but come with higher price tags. Inclusion of a drug on a formulary can also be used to drive volume discounts and rebates.

Formulary design is a fundamental way we make sure people have access to the safe, effective drugs they need, while providing savings and value to patients and the health system. 

• Policymakers should ensure health plans and pharmacy benefit specialists are able to maintain flexibility needed to deliver both access and affordability in formulary design.