Total Value FormulariesReal formulary strategy, beyond the rebate
Rebates matter, but they’re only one part of formulary value. Expion Health’s Total Value Formularies bring net cost, clinical alignment, member access and utilization strategy together—creating formulary strategies built for today’s pharmacy market.
Build your formulary around the full value equation
A formulary only creates value when net cost, clinical fit, utilization behavior, member access and rebate performance are evaluated together, not after one metric has already driven the decision.
Expion brings the intelligence, clinical expertise and modeling infrastructure to expose the tradeoffs behind every formulary decision, and to show clients what they’re trading away, not just what they’re gaining.
Model every formulary move before you make it
Formulary optimization starts with understanding what a change will actually do, clinically, financially and operationally.
Expion evaluates drug- and class-level opportunities across each client’s goals, target populations, lines of business and disruption guardrails.
Clinical fit
Net cost & rebate impact
Utilization shifts, intended and unintended
Member disruption
Market-share movement across manufacturers
Turn P&T into a formulary advantage
Expion Health® brings an independent pharmacy and therapeutics (P&T) committee structure that can supplement an existing process or serve as the P&T of record, giving organizations a stronger way to evaluate formulary decisions.
Independent Clinical Review
An external committee of physician and pharmacist experts reviews formulary decisions with clinical rigor, including specialty input when additional expertise is needed.
Medicare-Aware Governance
Committee structure and documentation support Medicare Part D considerations, including geriatric expertise and patient advocate perspective.
Support for Custom Formularies
Custom formulary strategies get the clinical review, documentation and decision support they need to move through governance, without the delay of an outside committee.
Value Assessment Committee
Bring a structured financial review to formulary strategy after clinical review, evaluating placement, tiering, preference status and UM criteria through rebate potential, utilization forecasts and cost modeling.
Build the framework that keeps formulary strategy on track
Formulary changes only work when clinical evidence and your financial goals are built in from the start. Expion designs formularies that connect those dots and provides ongoing support to keep strategy performing as the market and your population evolve.
Formulary Design & Oversight
Build template, tailored or fully custom formularies grounded in clinical evidence and designed to support your financial and operational goals.
Rebate Strategy & Formulary Alignment
Align rebate contracting with formulary strategy so clinical and financial decisions reinforce each other.
Utilization Management Library
Access an established library of UM criteria to support your formulary with clinical guardrails to guide utilization.
Net cost, delivered in real time
Members have always deserved to pay what a drug actually costs. Net Now closes the gap between what a plan receives in rebates and what a member pays at the pharmacy, delivering the true net cost in real time rather than settling up after the fact.
Expion models the financial variables, identifies where Net Now makes sense, and supports a phased approach that fits the broader formulary strategy.
Precise modeling of eligible claims, net cost opportunity, funding requirements, and member and plan impact
Flexible rollout options by drug category, therapy class, dollar threshold, or program priority
Real-time API connectivity that delivers net cost to the member at the moment of claims processing
Post-launch visibility into net cost delivery, member savings, utilization, and benefit performance
Keep every formulary move tied to the full Rx equation
Formulary decisions create more value when they stay connected to the strategy around them.
Our modular approach connects Total Value Formularies with access strategy, member affordability and ExpionIQ® intelligence so every formulary move builds on your strategy.
Next-Gen Access Solutions
Create more flexible pathways to appropriate therapy access as alternative sourcing channels, manufacturer programs and member expectations reshape how prescriptions get filled.
Member Affordability Solutions
Design affordability strategies that help reduce member cost barriers while strengthening pharmacy benefit performance.
The intelligence behind every modular move
ExpionIQ® powers the data, intelligence and activation behind Next-Gen Access Solutions, helping teams identify where emerging access pathways create value, support targeted engagement and keep every claim visible, no matter where it's filled.
When teams take back control, the Rx numbers change
Here's what happens when organizations partner with Expion to uncover savings, sharpen strategy, and act earlier on opportunities hidden inside their own pharmacy data.
Total Cost Savings
Maximum savings achieved through formulary optimization
Biosimilar Conversion
Conversion achieved through targeted formulary strategy
Rebate Yield Increase
First-year improvement with formulary and rebate optimization
The next pharmacy playbook is already being written
Get the Expion perspective on the trends, decisions, and market shifts redefining how pharmacy value is created.
Find the value your formulary is missing
See where your current formulary strategy may be leaving value behind across net cost, rebates, clinical alignment, utilization and member access.