FormularyDecisions : Registration

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Registration

Practice Setting

Please check this box to verify that you are a health care decision maker.

FormularyDecisions restricts entry to those individuals who are actively working in a capacity where health care, formulary, and/or benefit design decisions are a part of their role.
A few examples of eligible users may include: P&T Committee members, clinical pharmacists responsible for reviewing medications or managing formularies, and individuals who develop, implement, or advise health plans on various benefit design techniques.
Representatives from other industries, e.g., pharmaceutical, biotechnology, and medical device manufacturers, are not eligible for registration with FormularyDecisions.

If you have any concerns or questions, please contact us at

All information is required to complete your registration.
Your privacy is important to us! To learn more, please see our Privacy Policy.

Company Information

Company:

Organization Covered Lives:

Organization Geographical Coverage (i.e. State):

User Information

User id (email address):

Using your employer-provided email address for registration helps us ensure that Registered Users are, in fact, health care decision makers.

First Name:

Last Name:

Role:
Select all that apply


	Prepare product reviews/recommendations for P&T Committee

	P&T Committee member

	Rebate/contracting

	Student in rotation

	Pharmacist resident or fellow

Other (please specify):

Position:

Business Title:

Covered Lives That You (and / or Your Team) are Responsible for:

Geographical Coverage That You (and / or Your Team) are Responsible for (i.e. State):

Line of Business:


	Commercial

	Medicare

	Medicaid

	Exchange

	Self-Insured

	Employer

Other (please specify):

LinkedIn URL

How did you hear about FormularyDecisions?

Address:

City:

State:

Country:

ZIP Code:

Phone:

Password (?)
Enter Password:
Re-enter Password:

Professional Details

As part of the registration process, please describe your direct involvement in making formulary and/or benefit design decisions. Please note: If you are a health care decision maker, but do not hold a professional license (as required below), you may still describe your position as a decision maker and your request for registration will be considered during the verification process. Thank you!

Professional Degree:
Select all that apply

Professional License:

Name on License:

State of License:

State License #:

License Expiration Date:

Subject to Sunshine Act

Select this option if you are subject to Sunshine Act Reporting requirements. Your pertinent details will only be shared with the manufacturer for items that are subject to Sunshine Act reporting. Content subject to Sunshine Act Reporting will be indicated with

within FormularyDecisions.

Please describe your direct involvement in making formulary and/or benefit design decisions:

Verifying your status as a health care decision maker will be required in order for you to access select content and services. Your professional information will only be used for verification purposes.

Please check this box to verify that you are a health care decision maker.

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