OBJECTIVES:  To determine the types of approaches preferred by Medical and Pharmacy Directors (MDs+PDs) of US health plans, insurers, and pharmacy-benefit managers to enhance the P&T decision-making process and understand formulary reviews/coverage and changes from prior surveys. METHODS:  Online survey sent to 459 US MDs+PDs on: advisor+plan information; formulary coverage and restrictions. RESULTS:  The survey was completed by 52 MDs+PDs (11.3%): 55.8% were MDs and worked for: health plans/IDNs/PPOs/IPAs=57.7% ; PBMs=9.6%; Government=3.8%; the remainder consultants. Advisors/plans could cover multiple member-types: Commercial (54.2%=FFS; 70.8%=HMO/PPO), Medicaid (Traditional=22.9%;HMO/PPO=62.5%);Medicare (66.7%;Traditional=22.9%; PDP-only=45.8%) and Employer/Self-funded lives=66.7%. Clinician-administered products were always covered under the medical-benefit (55.6%,previously 64.3%), 4.4% (previously 5.4%) exclusively under the pharmacy-benefit, the remaining 35.6% (previously 32.7%) benefit coverage was threshold/plan-design based, changes were: not anticipated (77.8%,previously 70.9%); expected by 12/17=4.4%;by 12/18=13.3%;or by 12/19=4.4%. Parity policies were in place for self-administered and clinician-administered agents for: no plans=33.3%; select-plans=28.2%; all-members=25.6%; members in mandated-states=10.3%; commercial plans=7.7%; Medicaid plans=7.7%.Mental health [MH] products were carved-out by 35.9 of plans (previously 25.9%), conditions with multiple MH-therapies required: generics-first (41.2%,previously 50%), step-therapy (41.2%,previously 31.5%) or psychiatrist/specialist care (17.6%,previously 18.5%). MH parity policies were in place for: All=62.5%;None=10%;Mandated-states=15%; Commercial-plans=15%;Select-plans=10%;Medicaid-plans=7.5%; Never heard of=7.5%. Respondents involved in decisions for: prescription-drugs (All=75.0%,Some=18.2%,None=6.8%) and Medical-devices (All=43.9%,Some=41.5%,None=14.6%). Budget impact models were used in 73.2% of pharmaceutical and 63.2% of medical-device reviews. Biosimilar use is expected for all reference-product indications (59.5%), while 31.0% will restrict biosimilars to approved indications (31.0%). 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 managed care P&T Committee decision-making process is undergoing a series of changes. Medical and pharmacy directors, who commonly serve as P&T Committee members, have distinct opinions as to how to alter the process to adapt to these influences.