SYSTEMS AND METHODS FOR PROACTIVE IDENTIFICATION OF FORMULARY CHANGE IMPACTS
Systems and methods for proactively identifying impacts and making recommendations regarding modifications to a drug formulary are provided. In an embodiment, a proposed modification to a formulary is received. One or more data sources are accessed, and an impact of the proposed modification to the formulary is determined based on the one or more data sources. The impact of the proposed modification is then provided to a user prior to implementation of the proposed modification.
1 . A computer-implemented method for identifying impacts of a proposed modification to a formulary, the method comprising, by at least one hardware processor:
receiving a proposed modification to a formulary;
accessing one or more data sources;
determining an impact of the proposed modification to the formulary based on the one or more data sources; and
providing the impact of the proposed modification to a user prior to implementation of the proposed modification.
2 . The method of claim 1 , further comprising:
identifying one or more alternative modifications to the formulary; and
providing the one or more alternative modifications to the user.
3 . The method of claim 2 , wherein identifying one or more alternative modifications to the formulary comprises:
determining an impact of each of a plurality of potential modifications to the formulary; and
identifying one or more alternative modifications from the plurality of potential modifications having an impact that is more positive than the impact of the proposed modification to the formulary.
4 . The method of claim 1 , further comprising:
determining an impact of each of a plurality of potential modifications; and
identifying one or more optimal modifications from the plurality of potential modifications having a most positive impact.
5 . The method of claim 1 , wherein the formulary comprises a plurality of drug entries, wherein the one or more data sources comprises rebate information for one or more of the plurality of drug entries, and wherein the impact comprises at least one of an increase in rebate amount or decrease in rebate amount.
6 . The method of claim 1 , wherein the one or more data sources comprise member information, and wherein the impact comprises a number of members affected by the proposed modification.
7 . The method of claim 1 , wherein the one or more data sources comprise marketplace information, and the method further comprises predicting a shift in market share, resulting from the proposed modification, based on the marketplace information.
8 . The method of claim 1 , wherein the proposed modification to the formulary is received from the user, and wherein the accessing, determining, and providing are performed automatically in response to receiving the proposed modification to the formulary from the user.
9 . The method of claim 1 , wherein the formulary comprises a plurality of drug entries, arranged in two or more tiers, and one or more utilization management rules.
10 . The method of claim 1 , further comprising receiving either an approval or disapproval of the proposed modification to the formulary.
11 . A system for identifying impacts of a proposed modification to a formulary, the system comprising:
at least one hardware processor; and
at least one executable software module that, when executed by the at least one hardware processor,
receives a proposed modification to a formulary,
accesses one or more data sources,
determines an impact of the proposed modification to the formulary based on the one or more data sources, and
provides the impact of the proposed modification to a user prior to implementation of the proposed modification.
12 . The system of claim 11 , wherein the at least one executable software module further:
identifies one or more alternative modifications to the formulary; and
provides the one or more alternative modifications to the user.
13 . The system of claim 12 , wherein identifying one or more alternative modifications to the formulary comprises:
determining an impact of each of a plurality of potential modifications to the formulary; and
identifying one or more alternative modifications from the plurality of potential modifications having an impact that is more positive than the impact of the proposed modification to the formulary.
14 . The system of claim 11 , wherein the at least one executable software module further:
determines an impact of each of a plurality of potential modifications; and
identifies one or more optimal modifications from the plurality of potential modifications having a most positive impact.
15 . The system of claim 11 , wherein the formulary comprises a plurality of drug entries, wherein the one or more data sources comprises rebate information for one or more of the plurality of drug entries, and wherein the impact comprises at least one of an increase in rebate amount or decrease in rebate amount.
16 . The system of claim 11 , wherein the one or more data sources comprise member information, and wherein the impact comprises a number of members affected by the proposed modification.
17 . The system of claim 11 , wherein the one or more data sources comprise marketplace information, and the at least one executable software module further predicts a shift in market share, resulting from the proposed modification, based on the marketplace information.
18 . The system of claim 11 , wherein the proposed modification to the formulary is received from the user, and wherein the accessing, determining, and providing are performed automatically in response to receiving the proposed modification to the formulary from the user.
19 . The system of claim 11 , wherein the formulary comprises a plurality of drug entries, arranged in two or more tiers, and one or more utilization management rules.
20 . The system of claim 11 , wherein the at least one executable software module further receives either an approval or disapproval of the proposed modification to the formulary.
21 . A computer-implemented method for optimizing a formulary, the method comprising, by at least one hardware processor:
receiving one or more criteria;
accessing one or more data sources;
identifying a plurality of potential modifications to the formulary;
determining one or more impacts of the plurality of potential modifications to the formulary based on the one or more data sources;
determining an optimal set of the plurality of potential modifications based on the one or more criteria; and
providing the optimal set of the plurality of potential modifications to a user.
22 . The method of claim 21 , wherein determining an optimal set of the plurality of potential modifications comprises determining a subset of the plurality of potential modifications which substantially achieves the one or more criteria with a most positive impact.
23 . The method of claim 21 , wherein the formulary comprises a plurality of drug entries, wherein the one or more data sources comprises rebate information for one or more of the plurality of drug entries, and wherein the one or more impacts comprise at least one of an increase in rebate amount or decrease in rebate amount.
24 . The method of claim 21 , wherein the one or more data sources comprise member information, and wherein the one or more impacts comprise a number of members affected by the one or more of the plurality of potential modifications.
25 . The method of claim 21 , wherein the one or more data sources comprise marketplace information, and the method further comprises predicting a shift in market share, resulting from one or more of the plurality of modifications, based on the marketplace information.
26 . The method of claim 21 , wherein the formulary comprises a plurality of drug entries, arranged in two or more tiers, and one or more utilization management rules.
27 . The method of claim 21 , further comprising receiving either an approval or disapproval of the optimal set of the plurality of potential modifications.