Formulary Management
How PBMs decide which drugs are covered, at what tier, and under what conditions.
Tier Structures
From two-tier to six-tier formularies. How tier placement affects copays, coinsurance, and patient behavior.
Prior Authorization
When the PBM requires clinical justification before dispensing. The process, timelines, and impact on patient access.
Step Therapy
Fail-first requirements that mandate trying cheaper alternatives before accessing preferred medications.
Specialty Management
How formulary committees handle high-cost specialty drugs, limited distribution networks, and outcomes-based contracts.