A bitter pill: Formulary variability and the challenge to prescribing physicians
A bitter pill: Formulary variability and the challenge to prescribing physicians
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DOI：
10.3122/jabfm.17.6.401
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发表时间：
2004-11-01
期刊：
影响因子：
--
通讯作者：
Asch, SM
中科院分区：
文献类型：
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作者：
Shrank, WH;Ettner, SL;Asch, SM
背景：多层次的、基于激励的处方集越来越多地被用作控制处方药支出的一种机制。管理来自多个保险公司的患者的处方医生必须熟悉患者处方激励的可变性，以帮助患者明智地选择治疗。然而，随着时间的推移，健康计划之间和内部的处方变异的程度是不清楚的。方法：在6个主要的健康计划在加州，我们评估了处方激励变异4的5个药物类的最高支出在加州：质子泵抑制剂，羟甲基戊二酰辅酶A还原酶抑制剂（“他汀类药物”），钙通道阻滞剂，血管紧张素转换酶抑制剂。我们将这些类别的20个品牌成员分类为“首选”或非首选/未覆盖类别。我们计算了2000年至2002年期间，各健康计划中首选品牌的一致性，以及计划中每种药物处方集状态的变化频率。结果：2002年，所有处方集中没有一种被评估的品牌药物是首选的，10%的药物在任何处方集中都不可用。处方集状态在不同的计划中差异很大，在研究的6个处方集中，超过60%的药物首选2至4个。2000年和2002年之间，在超过一半的计划中的药物类evaluated.Conclusions：在药物类评价，在2年的时间内，相当大的变化之间，随着时间的推移，处方内的健康计划内的处方状态。这种变化性对希望通过在药物类别内的类似有效药物中开出最便宜的药物来减少患者支出的医生构成了挑战。这种变化尤其相关，因为最近的立法增加了更多医疗保险受益人从私人健康计划获得药物的可能性。
Background: Multitiered, incentive-based formularies have been increasingly used as a mechanism to control prescription drug expenditures. Prescribing physicians who manage patients from multiple insurers must be familiar with the variability in their patients' formulary incentives to help patients choose therapy wisely. However, the degree of formulary variability among and within health plans over time is unclear.Methods: In 6 major health plans in California, we evaluated formulary incentive variability in 4 of the 5 drug classes with the highest expenditures in California: proton pump inhibitors, hydroxymethylglutaryl coenzyme A reductase inhibitors ("statins"), calcium channel blockers, and angiotensin-converting enzyme inhibitors. We categorized 20 branded members of these classes into either "preferred" or nonpreferred/uncovered categories. We calculated the consistency that brands were preferred across health plans and the frequency of changes in formulary status for each drug within plans between 2000 and 2002.Results: None of the branded drugs evaluated were preferred on all formularies in 2002, and 10% were not available on any of the formularies. Formulary status varied greatly across plans, and more than 60% of drugs were preferred on 2 to 4 of the 6 formularies studied. Formulary status within health plans varied between 2000 and 2002 in more than half of the plans in the drug classes evaluated.Conclusions: In the drug classes evaluated, over a 2-year period, considerable variability was seen among and within formularies over time. This variability poses a challenge to physicians who wish to reduce patients' expenditures by prescribing the least expensive among similarly effective drugs within a drug class. This variability is especially relevant because recent legislation increases the likelihood that more Medicare beneficiaries will receive their medications from private health plans.