formulary

Finally, PBMs use their consolidated power to keep drugs off of health plan formularies — unless manufacturers pay exorbitant fees.

They negotiate drug prices with manufacturers on behalf of insurers, process prescription claims, and manage formularies — insurers' lists of covered drugs.

For example, Wegovy was added to the standard formulary for Medicare’s Part D prescription benefit after it received approval from the Food and Drug Administration in March for the treatment of heart attack risk.

DiGiacomo said her formulary, or list of covered drugs, has changed three times.

It cited "global manufacturing constraints, significant formulary losses impacting patient access effective in January 2024, and the availability of alternative options in the U.S. market" as key factors in the decision.