Do Open Formularies Increase Access To Clinically Useful Drugs?

Abstract

Before 1990 many state Medicaid programs maintained "restrictive" formularies, which denied reimbursement for unlisted prescription drugs. This type of formulary has been criticized for denying important medications to poor, medically needy persons. As part of the Omnibus Budget Reconciliation Act of 1990, restrictive formularies in Medicaid programs were disallowed. Based on research into the 200 top-selling prescription drugs in the United States, we conclude that eliminating Medicaid restrictive formularies improved access to a subset of the 200 best sellers, but that the majority of these products offered only questionable or no additional therapeutic benefit.

Effects of Noncardiovascular Comorbidities on Antihypertensive Use in Elderly Hypertensives

“…10 Although not present in PACE, restrictions on the number of prescriptions and formularies may deter antihypertensive use in other health care systems, especially among elderly with comorbidities. [45][46][47] This study confirmed some previous findings regarding correlates of antihypertensive use. The reduced use seen previously among the oldest old may be attributable to their more limited abilities to pay for and access care, real or perceived frailty, and even outright "ageism."…”

“…57,58 Expanding drug coverage may be needed to ease financial barriers faced by patients with multiple conditions. 46,47 Drug utilization review programs could alert physicians to instances of suboptimal antihypertensive use 45 and performance standards 59 or "report cards" (eg, National Committee for Quality Assurance standards 60 ) could help monitor the impact of interventions on antihypertensive use in patients with comorbidities. A combination of all of these may be needed if the quality of hypertension care and the clinical outcomes of vulnerable elderly with comorbidities are to be improved.…”

Assessing the effects of drug price reduction policies on older people in Taiwan

“…The policies are based on the 'r-zone' mechanism, which operates as follows. (1) No adjustment is necessary if the market price is higher than or equal to (1 2 r) Â the current drug reimbursement rate. For example, if r is set at 30% and the current reimbursement rate is $10, no adjustment is needed if the market price is equal to or higher than $7.…”

Medicaid Prescription Formulary Restrictions and Arthritis Treatment Costs

“…15 It remains an important but unanswered question whether formularies that are more restrictive reduce or increase spending on medical care and prescription drugs. Most studies have not evaluated potential substitution effects (i.e., greater use of nonrestricted drugs or other nondrug health services) in a well-controlled manner.…”