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What are the differences between open and closed formularies?

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If you are a sales professional in the healthcare industry, you need to understand how formularies affect your market access and sales strategy. Formularies are lists of drugs that are covered by health insurance plans or other payers. They can be classified into two main types: open and closed. In this article, you will learn the differences between these two types of formularies and how they impact your sales opportunities and challenges.

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Anoop Singh

International Sales & Marketing Time Medical Systems | Founder MRI Sikho | Co-Founder Pronounce Solar | MRI Safety |…

1 Open formularies

Open formularies are formularies that cover most or all drugs in a therapeutic class, regardless of their cost or efficacy. This means that patients and prescribers have more choices and flexibility when it comes to selecting a drug. However, open formularies may also impose some restrictions or incentives to encourage the use of preferred or lower-cost drugs. For example, they may use tiered copayments, prior authorization, step therapy, or quantity limits. As a sales professional, you can benefit from open formularies by highlighting the value and differentiation of your product, as well as providing clinical and economic evidence to support its inclusion and preference.

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Anoop Singh

International Sales & Marketing Time Medical Systems | Founder MRI Sikho | Co-Founder Pronounce Solar | MRI Safety | Clinical Expert
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Open formularies encompass a wide range of drugs within a therapeutic class, regardless of cost or efficacy. This approach allows patients and prescribers greater freedom to choose medications based on individual needs and preferences. In open formularies, there are fewer restrictions, providing flexibility in drug selection. This contrasts with closed formularies, which have limited drug options and often require prior authorization, making open formularies more inclusive and accommodating to diverse patient needs.

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2 Closed formularies

Closed formularies are formularies that only cover a limited number of drugs in a therapeutic class, usually based on their cost-effectiveness or clinical outcomes. This means that patients and prescribers have fewer options and may face barriers to access certain drugs that are not on the formulary. However, closed formularies may also offer some exceptions or appeals for drugs that are medically necessary or have no alternatives. As a sales professional, you can face challenges from closed formularies by identifying and targeting the decision-makers and influencers who determine the formulary status and criteria, as well as providing patient assistance and access programs to overcome reimbursement hurdles.

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Anoop Singh

International Sales & Marketing Time Medical Systems | Founder MRI Sikho | Co-Founder Pronounce Solar | MRI Safety | Clinical Expert
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Closed formularies restrict coverage to a select few drugs within a therapeutic class, typically chosen based on cost-effectiveness and clinical outcomes. These formularies provide a narrower range of options to patients and prescribers, often requiring prior authorization for medications not included in the list. Unlike open formularies, closed formularies impose limitations, aiming to control healthcare costs while promoting the use of specific, approved medications.

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3 Formulary changes

Formularies are not static; they can change over time due to various factors, such as new evidence, market dynamics, regulatory changes, or payer policies. These changes can affect the availability, affordability, and utilization of drugs on the formulary. As a sales professional, you need to monitor and anticipate formulary changes and adjust your sales strategy accordingly. You can use market access data and analytics tools to track and analyze formulary changes and their impact on your product and competitors. You can also communicate and collaborate with payers, prescribers, and patients to address any concerns or opportunities arising from formulary changes.

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Anoop Singh

International Sales & Marketing Time Medical Systems | Founder MRI Sikho | Co-Founder Pronounce Solar | MRI Safety | Clinical Expert
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Formularies are dynamic and subject to changes influenced by factors like new evidence, market dynamics, regulations, and payer policies. These shifts impact drug availability, affordability, and utilization within healthcare systems. Pharmaceutical companies, healthcare providers, and patients must stay updated on formulary changes to make informed decisions regarding medication choices, ensuring access to the most effective and economical treatments while adapting to evolving healthcare landscapes.

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4 Formulary types and sales performance

The type of formulary that your product is on can have a significant impact on your sales performance and market share. Generally, products that are on open formularies have higher sales potential and market penetration than products that are on closed formularies. However, this also depends on other factors, such as the level of competition, the degree of differentiation, the strength of the value proposition, and the quality of the customer relationship. As a sales professional, you need to understand how formulary types affect your sales performance and market share, and leverage your strengths and mitigate your weaknesses accordingly.

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5 Formulary types and customer segments

The type of formulary that your product is on can also influence your customer segments and their needs and preferences. Different customer segments may have different formulary types, depending on their payer type, plan design, population size, and disease burden. For example, Medicare Part D plans tend to have more open formularies than Medicaid or commercial plans, while specialty drugs tend to have more closed formularies than primary care drugs. As a sales professional, you need to segment your customers based on their formulary types, and tailor your sales approach and message to their specific needs and preferences.

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6 Formulary types and sales skills

The type of formulary that your product is on can also require different sales skills and competencies. Depending on the formulary type, you may need to focus more on clinical or economic value, relationship or consultative selling, access or outcome-oriented selling, or account or individual selling. As a sales professional, you need to develop and refine your sales skills and competencies based on the formulary type, and demonstrate your expertise and credibility to your customers.

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7 Here’s what else to consider

This is a space to share examples, stories, or insights that don’t fit into any of the previous sections. What else would you like to add?

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What are the differences between open and closed formularies?

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1 Open formularies

2 Closed formularies

3 Formulary changes

4 Formulary types and sales performance

5 Formulary types and customer segments

6 Formulary types and sales skills

7 Here’s what else to consider

Sales

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What are the differences between open and closed formularies?

1

2

3

4

5

6

7

1 Open formularies

2 Closed formularies

3 Formulary changes

4 Formulary types and sales performance

5 Formulary types and customer segments

6 Formulary types and sales skills

7 Here’s what else to consider

Sales

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