MANAGED CARE January 2005. ©MediMedia USA
THE FORMULARY FILES
Formulary variability challenges physicians
A recent study indicates that more than 60 percent of drugs were preferred on two to four of the six California formularies evaluated.
"We described how much variability there was exhibited between formularies. The more variability, the harder it is for doctors to act as agents on behalf of their patients," says William H. Shrank, MD, lead author of the study. The researchers evaluated proton-pump inhibitors, statins, calcium-channel blockers, and ACE inhibitors. None of the drugs were preferred on all formularies in 2002, and 10 percent were not available on any of the formularies.
| Formulary placement status of five major drug classes | ||||||||
|---|---|---|---|---|---|---|---|---|
| Total formularies* offering drug in ... | ||||||||
| Agent | Blue Shield | Aetna | HealthNet | Pacificare | Blue Cross | Cigna | 2000 | 2002 |
| Proton-pump inhibitors | ||||||||
| Rabeprazole | 00/02 | 00/02 | 00/02 | 00/02 | NP | 02 | 4/6 | 5/6 |
| Esomeprazole | NP | NP | NP | NP | NP | NP | 0/6 | 0/6 |
| Lansoprazole | NP | 00/02 | NP | NP | 00/02 | 00/02 | 3/6 | 3/6 |
| Omeprazole | NP | NP | 00 | NP | NP | NP | 1/6 | 0/6 |
| Pantoprazole | 00/02 | NP | 00/02 | 00/02 | 02 | 02 | 3/6 | 5/6 |
| Statins | ||||||||
| Fluvastatin | 00/02 | 00/02 | 00/02 | NP | 00 | 02 | 4/6 | 5/6 |
| Atorvastatin | 00/02 | NP | 00/02 | NP | 00/02 | NP | 3/6 | 3/6 |
| Pravastatin | 02 | NP | 00/02 | 00/02 | NP | 00/02 | 3/6 | 4/6 |
| Simvastatin | NP | 00/02 | NP | 02 | NP | 00/02 | 2/6 | 3/6 |
| Calcium channel blockers | ||||||||
| Nicardipine | NP | 02 | NP | 00/02 | NP | 00 | 2/6 | 2/6 |
| Isradipine | NP | NP | NP | 00/02 | 00/02 | 00/02 | 3/6 | 3/6 |
| Amlodipine | NP | 00/02 | 00/02 | 00/02 | 00/02 | NP | 4/6 | 4/6 |
| Felodipine | 00/02 | 00 | 00/02 | 00/02 | 00/02 | NP | 6/6 | 5/6 |
| Nisoldipine | 00/02 | NP | 00/02 | 00/02 | 00/02 | NP | 4/6 | 4/6 |
| ACE inhibitors | ||||||||
| Quinapril | NP | 00/02 | 00/02 | 02 | 00/02 | 00/02 | 4/6 | 5/6 |
| Ramipril | NP | 02 | 02 | 02 | 02 | 02 | 0/6 | 5/6 |
| Benazepril | 00/02 | NP | 00/02 | 00/02 | 00/02 | 00/02 | 5/6 | 5/6 |
| Trandolapil | NP | 02 | NP | 02 | 00/02 | 00/02 | 2/6 | 4/6 |
| Moexipril | 00/02 | NP | 00/02 | NP | NP | 02 | 1/6 | 3/6 |
| Legend: 00, preferred in 2000; 02, preferred in 2002; NP, nonpreferred in 2000 or 2002. *Fraction is the number of plans over the total number of plans studied SOURCE: A BITTER PILL: FORMULARY VARIABILITY AND THE CHALLENGE TO PRESCRIBING PHYSICIANS. J AM BOARD FAM PRACTICE. 2004 NOV-DEC;17(6):401–407. | ||||||||
