The book · Chapter 3 of 16 · 2013–2016 · Evidence · 4 minutes
By Unnat Patel
Chapter 03 · Explore the idea
Billing, rebates, pharmacy networks, member communications and clinical policy depend on formulary information.
Drug-list maintenance came first. The enterprise catalog and subsequent API reuse were later work.
Drug-list maintenance and the later enterprise catalog were distinct work; both made master data a product.
Inside the decision
Coverage and its rules affect several business and clinical workflows.
A formulary is a list of drugs a plan covers, and the rules for how. It sounds like a document. It is actually a data product that touches billing, rebates, pharmacy networks, member communications and clinical policy, and when the workflows behind it are manual, every department keeps its own version of the truth.
Inside the decision
I owned formulary workflows and worked across business, design and quality assurance.
As a product owner at a health-services business I owned those workflows. We reconstructed billing-related formulary processes and took avoidable effort out. I worked as the subject-matter expert across business, design and quality assurance for specialty pharmacy, rebate billing, claims, reporting and the data mart that fed it.
Inside the decision
The enterprise drug catalog in 2018–2022 replaced department-by-department lists with a shared master.
During the formulary years I owned drug-list maintenance. The enterprise drug catalog came later, in 2018–2022: it replaced department-by-department lists with a shared master sourced from First Databank and Medi-Span, a data model and workflow roles for creating, approving and publishing lists. Existing APIs from that catalog were later reused by a sales application, avoiding a recurring drug-data subscription.
Inside the decision
The later catalog combined a data model with explicit workflow roles.
During the formulary years I owned drug-list maintenance. The enterprise drug catalog came later, in 2018–2022: it replaced department-by-department lists with a shared master sourced from First Databank and Medi-Span, a data model and workflow roles for creating, approving and publishing lists. Existing APIs from that catalog were later reused by a sales application, avoiding a recurring drug-data subscription.
Inside the decision
A sales application later reused the catalog’s existing APIs, avoiding a recurring drug-data subscription.
During the formulary years I owned drug-list maintenance. The enterprise drug catalog came later, in 2018–2022: it replaced department-by-department lists with a shared master sourced from First Databank and Medi-Span, a data model and workflow roles for creating, approving and publishing lists. Existing APIs from that catalog were later reused by a sales application, avoiding a recurring drug-data subscription.
A formulary is a list of drugs a plan covers, and the rules for how. It sounds like a document. It is actually a data product that touches billing, rebates, pharmacy networks, member communications and clinical policy, and when the workflows behind it are manual, every department keeps its own version of the truth.
As a product owner at a health-services business I owned those workflows. We reconstructed billing-related formulary processes and took avoidable effort out. I worked as the subject-matter expert across business, design and quality assurance for specialty pharmacy, rebate billing, claims, reporting and the data mart that fed it.
During the formulary years I owned drug-list maintenance. The enterprise drug catalog came later, in 2018–2022: it replaced department-by-department lists with a shared master sourced from First Databank and Medi-Span, a data model and workflow roles for creating, approving and publishing lists. Existing APIs from that catalog were later reused by a sales application, avoiding a recurring drug-data subscription.
Master data is a product. That is the lesson I take from both maintenance and enterprise catalog work.
Tools and standards referenced in this chapter SQL Server · SSIS · SSRS · Jira · First Databank · Medi-Span · GPI / GCN / NDC drug identifiers · rebate and MAC pricing logic