Formul8 Clears the Way for Transparency into your Pharmacy Spend

Last week it was announced that starting in 2019, Medicare Advantage Plans are going to have more latitude to negotiate directly with manufacturers on Part B drug prices. 

As a part of this change, Medicare Advantage plans will be able to apply step therapy rules on the Part B benefit for the first time.   This is being implemented so that Medicare beneficiaries can get the “best of” pricing between their Part B and Part D benefits. 

This is a nod to the Medicare Advantage program acknowledging that they have been successful in holding down drug prices.  Additionally, this is only a first step toward the more sweeping changes in the Part B and Part D programs that President Trump outlined in his plan to lower drug prices on May 11th.  These changes will likely include:

  • Additional utilization management options for the Part B benefit
  • Further integration of the Part B and D benefits within the Medicare Advantage program
  • Expansion of the Medicare Advantage plans’ ability to negotiate Part B drug prices and move away from the Average Sales Price (ASP) approach

These changes certainly create a need for health plans to evolve the current relationship with their Pharmacy Benefit Manager (PBM).  For most health plans, the PBM does not adjudicate both the pharmacy benefit (Part D) and the medical pharmacy benefit (Part B).   As such they are unable, and frankly uninterested, in proactively identifying opportunities across the full Pharmacy benefit.

At Pulse8, we have spent the last year developing a new product in anticipation of these events.  We are proud to say that this solution, Formul8, will assist payers as they navigate these changes.  This new game-changing product:

  • Provides transparency to your pharmacy spend and identifies drug cost and utilization opportunities across your full pharmacy spend using industry standard benchmarks
  • Supports your member, prescriber and pharmacy interventions through advanced analytics and engagement registries
  • Includes value-based agreements incorporating unit cost, quality, and clinical outcome guarantees
  • Puts you in control of your pharmacy program data as well as reporting and analytics in order to reduce PBM transition costs and increase negotiating leverage                            

Often referred to as “The Great One”, and arguably the best hockey player of all time, Wayne Gretzky once said that his success as a hockey player was due to his ability to skate to where the puck was going to be.  Not only does Pulse8 love hockey, but we also like to emulate Gretzky during a time when it is most needed by providing solutions for health plans to gain the clarity they’re seeking when working with their PBM.  We’re on a mission to eliminate waste, create financial transparency, and to act as a source of truth for your pharmacy management program.  The industry has been talking about rising costs and lack of transparency with these middlemen, and we have decided to do something about it by skating where the puck will be – the need for better financial performance, improved operations, and portability of your pharmacy management program.

To learn more about Formul8 and how it can help your health plan gain the transparency and clarity that are imperative to optimizing your financial performance, contact us to set up a live demo.

Request a Demo

For all general and sales inquiries, please contact us at 410.928.4218 or email us at

Thank you! Your submission has been received!

Oops! Something went wrong while submitting the form