R.Ph.S Welcome New Formulary Disclosure Rules
Gebhart, Fred, Drug Topics
At least two states, California and Texas, now require managed care organizations (MCOs) to reveal their drug formularies, along with any planned formulary changes, and other states may follow suit. In California, too, health maintenance organization regulators have been trying to reverse scores of formulary deletions at six major HMOs and are investigating formulary procedures at another 36 MCOs. In general, there is growing pressure to base formulary decisions on medical considerations, rather than on product cost and manufacturer rebates, which pharmacy groups are applauding.
"Product availability is the key to drug therapy and continuity of care," said Carlo Michelotti, CEO of the California Pharmacists Association (CPhA). "Tampering with formularies obstructs care for patients."
California and Texas are the only states to require disclosure of formularies, but other states are looking at similar legislation, said Susan Winckler, director of policy and legislation for the American Pharmaceutical Association. She thinks formulary decisions could use a little sunshine. Formularies may be practical for the hospital environment, where a limited number of prescribers have time to learn how to work with a limited number of drug choices, she said. However, in ambulatory care, where prescribers and pharmacists must deal with dozens of different health plans and coverage limits, formularies are a major headache.
Carmen Catizone, executive director of the National Association of Boards of Pharmacy, also wants to illuminate the formulary shadows. He expects better disclosure to bring more R.Ph.s and more medical-based decisions to the formulary. "If the formulary process is brought to light, it will increase pressure on MCOs to pay greater attention to patient needs and outcomes," he said. "If formulary changes are a financial decision, the plan is going to draw a lot of heat. Better disclosure will force plans to pay greater attention to patient care needs in their decisions. …