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Impact of formulary restrictions on patient safety.

Article Excerpt
Although many new therapies are extremely cost effective for people with acute and chronic conditions, changes in drug benefits have been designed to shift costs to consumers and discourage use of expensive pharmaceuticals.

Increasingly, physician executives are becoming involved in deliberations related to the use of newer medications because of requirements that these drugs be "prior authorized" or have "preferred" status on a drug formulary.

Unfortunately, individuals may be denied access to the most effective medications, resulting in substantial morbidity and mortality in high-risk populations such as the poor and the elderly, as well as individuals with diabetes, asthma, mental illnesses and other conditions.

The negative health consequences of formulary restrictions are often reflected in greater use of medical services downstream.

Evidence surfaces

Evidence of formulary decisions harming patients with serious illnesses is just beginning to surface.

For example, increasing co-payments for prescription drugs may reduce patients' use of these drugs, the Rand Corporation reported. (1) In linking pharmacy claims data of patients who all had employer-sponsored health insurance with health benefit designs from 52 private health plans and 30 employers, researchers found that doubling co-payments in a typical two-tier drug plan resulted in an approximately 45 percent reduction in the use of anti-inflammatory drugs and antihistamines.

In addition, there was a 35 percent drop in the use of cholesterol-reducing medications and...