Rx Product Release - Version 4.3 (B) | May 2026

Formulary EQ

Formulary-EQ is a new capability that brings formulary intelligence directly into the financial analysis. Rather than repricing a client's existing claim file as-is, Formulary-EQ incorporates each PBM's anticipated drug utilization shifts — driven by their formulary's coverage, tiering, and restrictions — to model what spend and rebates would actually look like under their formulary. The result is a richer, more complete picture of projected performance under each competing proposal.

With this release, Formulary-EQ is now live in the Financial Summary. A Formulary EQ section will appear on all RFPs, housing three sliders that give you precise control over your formulary assumptions:

• Formulary Optimization — Controls the impact of formulary-driven drug shifts across all claims outside of Humira and Stelara.
• Humira Optimization — Controls the impact of Humira-to-biosimilar shifts.
• Stelara Optimization — Controls the impact of Stelara-to-biosimilar shifts.

The Humira and Stelara sliders are the same ones previously found in the Clinical EQ section — they've simply moved here to consolidate all formulary-related assumptions in one place. They will continue to default to the optimization levels reflected in the incumbent claims data. The Formulary Optimization slider is new and defaults to 0%, meaning no formulary impact is applied until you actively adjust it. As the slider is moved toward 100%, a greater share of the projected formulary shifts are credited in the financial analysis — with 100% representing the full impact of every anticipated drug change reflected in the formulary data.

The resulting impact of each slider is broken out in dedicated Formulary Adjustment, Humira Adjustment, and Stelara Adjustment rows, showing how each set of assumptions affects both gross drug costs and rebates.

If a PBM has not linked a Formulary EQ list to their bid, you will see "Unavailable List" in the Financial Summary for that proposal. You can also check the Formulary Name field in the Rebates section (Step 3) of any bid to see the linked formulary. If "Other" is listed that means the PBM has elected to provide an open text response instead of linking a formulary.

One thing to keep in mind: PBM participation in Formulary-EQ is opt-in, and it may take some time for PBMs to get their formulary alternative lists uploaded and linked. Availability will grow as more PBMs engage with the feature.