Formulary Management

VativoRx offers several formulary options

Premium Formulary

Our Premium Formulary is a three-tier partially-closed formulary with a minimum copayment differential of $10 between tiers. Tier 1 includes all generics. Tier 2 consists of mid-range, commonly used brand drugs, also known as preferred brand drugs. Tier 3 consists of higher cost brand drugs, also known as non-preferred brand drugs. All specialty drugs, including injectable drugs, are tiered based on our specialty drug list.

Members continue to have access to clinically appropriate treatments through use of lower-cost brand, generic, and over-the-counter alternatives. By excluding certain prescription drugs, we negotiate more aggressive discounts or higher rebates for drugs intended to treat the same condition. This provides a lower overall net cost for your company and maintains affordable options for your employees.

Our Premium Formulary also encourages members to use lower-cost alternatives through exclusion of 76 drugs across 25 therapeutic classes.

We offer Prior Authorization (PA) programs for the following four specialty therapeutic classes:

Therapeutic Class Preferred Medications
Hepatitis C Harvoni, Sovaldi
Immunomodulators Cimzia, Humira, Simponi, Stelara
Multiple Sclerosis Avonex, Copaxone, Plegridy, Tecfidera
High Cholesterol Praluent (PCSK-9 inhibitor)

Select Formulary

Our Select Formulary is a three-tier open formulary with a minimum copayment differential of $10 between tiers. The types of drugs included in each tier are the same as with the Premium Formulary. Also, all specialty drugs, including injectable drugs, are tiered based on our specialty drug list.

Generic-Centric Formulary

Our Generic-Centric Formulary is a two-tier closed formulary and our most aggressive offering, which limits coverage primarily to generic drugs. In classes where there are few, if any, clinically effective generics, preferred brand drugs are included. Non-preferred drugs are excluded.