2005_01 | Formulary variability challenges physicians

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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.

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

4/6

5/6

Esomeprazole

0/6

Lansoprazole

00/02

3/6

Omeprazole

1/6

0/6

Pantoprazole

00/02

3/6

5/6

Statins

Fluvastatin

00/02

4/6

5/6

Atorvastatin

00/02

3/6

Pravastatin

00/02

3/6

4/6

Simvastatin

00/02

2/6

3/6

Calcium channel blockers

Nicardipine

00/02

2/6

Isradipine

00/02

3/6

Amlodipine

00/02

4/6

Felodipine

00/02

6/6

5/6

Nisoldipine

00/02

4/6

ACE inhibitors

Quinapril

00/02

4/6

5/6

Ramipril

0/6

5/6

Benazepril

00/02

5/6

Trandolapil

00/02

2/6

4/6

Moexipril

00/02

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.