OBJECTIVES : Understand the P&T decision-making process, formulary reviews/coverage and changes from prior surveys.

METHODS : Online survey sent to 737 US medical and pharmacy officers on: respondent+plan information, formulary coverage/restrictions.

RESULTS : Survey completed by 77 respondents, 57% were MDs, 43% were the senior officer,19% were payor specific, 9.9% regional, 1.3% therapeutic area specific. 40.5% worked for health plans, 11.4% PBMs, 8.9% IDNs, 3.8% PPOs/IPAs,1.3% Government. Plans were National=39.2%,regional=27.5%,or local=33.3% and cover multiple members-types: commercial (68.8%=FFS,76.5%=HMO/PPO), Medicaid(Traditional=36.4%,HMO/PPO=67.9%), Medicare(71.2%,PDP-only=50%), Employer/Self-funded=77.1%,and IDN(47.7%,340B=43.5%). Plans covered clinician-administered products under the medical-benefit (44.1% ↑ from 15.2%), 1.4% under the pharmacy-benefit, the remainder based on price+plan design, 72. 9% do not expect changes. Parity policies are in place for self-administered and clinician-administered agents for: no plans=24.4% (↓ from 33.3%), select-plans=28.9%, all-members=20%(↓ from 25.6%), mandated-states=8.9%, commercial plans=8.9%, Medicaid plans=8.9%. Mental health (MH) products were carved-out by 27.3% of plans (↓ from 35.9%), conditions with multiple MH-therapies required: generics-first (63.8% ↑ from 41.2%), step-therapy (68.1% ↑ from 41.2%) or Psychiatrist/specialist care (29.8% ↑ from 17.6%). MH parity policies were in place for: All=54% (↓ from 62.5%), None=2% (↓ from 10%), Mandated-states=18%, Commercial-plans=16%, Select-plans=12%,Medicaid-plans=14% (↑ from 7.5%), Never heard of=10%. Respondents are involved in coverage decisions for: Rx-drugs (All=65.6%,some=32.8%) and Medical-devices (All=34.5%,some=58.2%). 88.2% of Rx and 81.6% of medical-device reviews included budget impact models and 42.3% of the models were solely developed internally, the remaining in combination with the manufacturers. Biosimilar use is expected to provide some relief. Most respondents were happy with their medical-benefit, the most request change was moving all drugs to the pharmacy-benefit. Top concerns today and in the future included Oncology, Diabetes and Cardiovascular diseases.

CONCLUSIONS : The P&T decision-making process continues to change to better manage increasing costs and committee members, have distinct opinions as to how to alter the process to adapt to these influences.