Managed Care

Patients, HMO win with cheaper drug













It’s pretty common. A health plan decides to change its formulary, looking for ways to decrease costs. But formulary selections affect the provider’s choice of medication and the patient’s satisfaction with therapy. Researchers at Wilkes University in Wilkes Barre, Pa., looked at surrogate outcomes when a potent statin, atorvastatin (Lipitor), was removed from the formulary of a Medicaid HMO. Surrogate outcomes are laboratory results or vital signs.

“We were alarmed by how this change might affect patient lipid panels,” says Daniel S. Longyhore, PharmD, of the department of pharmacy practice at Wilkes University and lead investigator.

The researchers expected poorer outcomes. They also thought poorer outcomes could help make the case to the HMO to reconsider its formulary choices.

“That didn’t happen,” says Longyhore. “Patients were just as well controlled by drugs that were not as potent as atorvastatin and that were available in generic form. This was a significant cost savings to the patient and the plan, plus a blessing to find these good surrogate outcomes.”

For payers, “It’s a sign that sometimes it’s better to stick to the medication that has been around for awhile, that has proven itself, that is less expensive, and that is just as good as newer drugs,” says Longyhore.

Removing a high-potency statin from the formulary did not change lipid panels significantly

Source: Longhyore DS, Stockton CM, Thomas MR. Lipid profile changes associated with changing available formulary statins: Removing higher potency agents. 2009. Am J Manag Care. 15:409–414.

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