Insurer coalition creates drug formulary site

The Council for Affordable Quality Healthcare will also offer a single-application credentialing service for physicians.

By Tyler Chin, amednews staff. Aug. 5, 2002.

A nonprofit coalition of the nation's major insurance companies has rolled out a service that lets physicians go to a Web site to check whether medications they prescribe are on the insurers' drug formularies.

Under the service, called Formulary DataSource, doctors enter a drug's brand or generic name to see if it is on the formulary of the patient's health plan. If it is not, they search the sites' database to identify medications in the same therapeutic class.

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Members of the coalition, called the Council for Affordable Quality Healthcare, also are expanding a separate service that lets physicians submit a universal standardized application online to satisfy their credentialing requirements. Both the formulary and credentialing services are free to doctors.

Physicians and employees at Tidewater Physician Multispecialty Group, Newport News, Va., which helped test the service, said it will save them time because they can go to one place to access up-to-date information instead of having to flip through directories from different insurers.

Even though doctors can only check formulary information and use the standardized credentialing form with the approximately 30 CAQH members, the initiatives are significant because those member insurers contract with 600,000 doctors and insure nearly 100 million Americans. Members include Aetna, CIGNA Corp., Anthem Blue Cross and Blue Shield, Oxford Health Plans and Health Net Inc.

Also, CAQH hopes that its tools will be used or adopted outside its membership. It will invite nonmembers to download their formularies into its database and to adopt its standardized credentialing application, said Jay Gellert, president and CEO of Health Net and chair of the coalition's Administration Simplification Coalition.

As of mid-July, about 18 CAQH health plans had downloaded 30 formularies into the online database, which will be updated regularly. The remaining health plans are expected to download their formularies in the near future.

The online credentialing service is available in Colorado and Virginia, which served as the test sites. It will be rolled out in Connecticut, Maryland, New Jersey, New York and Washington, D.C., by the end of 2002. The goal is to make it available to all other states by Jan. 1, 2004, Gellert said.