Model N Formulary Compliance

Ineffective formulary evaluations restrict patient access to medication, while inaccurately implemented formularies cost manufacturers millions of dollars.

Formulary requirements, including tier adjustments, step therapies, prior authorizations, and quantity limits, change frequently, often without advance notice.
Without a systematic approach, manufacturers validate only a subset of high-value plans annually, leaving the majority of contracts unreviewed.
Validating compliance within rebate payment cycles requires consolidating inconsistently formatted data from pharmacy benefit managers, health plans, and pharmacy vendors, which is often locked in access-controlled systems.

Benefits of Model N Formulary Compliance

Maximize market access

Ensure your drugs receive the prioritized positioning outlined in payer and pharmacy benefit manager contracts.

Reduce revenue leakage

Thoroughly audit all products across plans within payment cycles, not after the fact through months of disputes, to reduce overpayments.

Streamline operations

Access up-to-date formulary data throughout the year for accurate, efficient, and comprehensive validations without sampling or guesswork.

Improve payer satisfaction

Ensure prompt, accurate rebate payments and reduce the need for post-payment recovery and settlement disputes.

10%

On average, manufacturers using Model N Formulary Compliance achieve approximately 10% savings on rebate spend—translating to significant protected revenue depending on company size.

Eliminate the need for internal manual validations or third-party audits

Model N Formulary Compliance is a full-service automated data and formulary auditing solution.

Integrated data

Access collected and consistently stewarded formulary data that covers most commercial and government plan formularies across all therapeutic areas.

Script-level formulary compliance

Compare contractual terms and conditions that drive rebates with published formulary data to determine formulary compliance at the prescription level.

Reporting and visibility

Gain insight into formulary compliance outcomes and trends to support account management and future contract negotiations.

Evaluate formulary compliance during rebate processing

Doctor using computer Document Management System (DMS), online documentation database process automation to efficiently manage files

Model N Formulary Compliance integrates with Model N Payer Management and Model N Validata to provide an end-to-end solution for managing payer contracts. This robust solution streamlines processes, improving calculation accuracy and preventing overpayments.