Formulary Management

When properly constructed, formularies are a crucial strategy for keeping prescription medications affordable while preserving access for the plan members who need them.

Open Express Scripts Canada Pharmacy pill bottles with colourful pills

Effective strategies mitigate costs

ESC’s drug formulary solutions are evidence-based and enable plan sponsors to develop flexible, cost-effective strategies that empower better plan member decisions.

Under the guidance of our experienced clinical team, we leverage a number of diverse formularies and programs to help our clients manage drug plan costs. ESC formularies are developed based on the efficacy, safety and cost effectiveness of brand name and generic prescriptions drugs as approved to be prescribed by Health Canada.

Our priority is to ensure that our clients are well positioned to offer a broad range of drug formularies to meet their clients’ needs. Built on a philosophy to fit your needs, we offer a vast array of flexible formulary options and have the unique ability and expertise to customize formularies.

We focus on improving member health outcomes by ensuring that they receive the right drug at the right time for the right reason and helping plan sponsors proactively manage their drug spend by making value-driven decisions.

Managed formularies

Express Scripts Canada offers two formularies: managed and custom. The Dynamic Therapeutic Formulary (DTF) is a two-tiered formulary that combines the benefits of a managed formulary with the flexibility of a traditional drug plan. Designed to provide clinically effective and affordable drug coverage for plan members and educate them about the cost of drugs, the DTF consists of a defined list of drugs that are reviewed on a monthly basis to assess their therapeutic effectiveness and determine the most effective and affordable alternatives for plan members. Our client formularies allow plan sponsors to build a formulary that best meets the needs of their member community within their healthcare budget. 

Traditional open formularies

We offer comprehensive drug coverage through traditional formularies that ensure plan members have the broadest access to drugs available, regardless of tier, to fill their prescriptions. This allows members to choose options that are just as safe and effective as costlier, brand name alternatives, and when brand name drugs and their generic equivalents are available on the same tier – for the same copay – it drives lower costs with every refill.

Provincial integration program

Our enhanced drug claims management process helps ensure that plan members access additional coverage opportunities available under provincial drug programs.  This program recognizes when a drug claim is submitted as part of a provincially funded program under the provincial formulary or part of a provincial disease program thereby enabling the member to submit their request to the provincial plan for coverage first to receive reimbursement from both public and private drug plans.

A hand holding a pack of pills with other pills in the background