Pharmaceuticals may be a modest piece of the health care pie, but modest doesn't mean insignificant. HMOs and pharmacy benefit managers, often working together, continue to put pressure on physicians to prescribe, and pharmacists to dispense, certain drugs. The formulary is the best-known device; many patients now know about this list of approved drugs. But there are many ways — involving prescriber, dispenser and consumer — in which cost-effective drug use is encouraged. (Data for 1997 and 1998 are projections.)
HMO, employer and PBM formulary design
The levels differ, but the trend is the same.
The open formulary is waning, the closed formulary gaining. Employers, who must be responsive to employees, understandably lag behind HMOs and PBMs, but they're moving in the same direction.
Source: PHARMACY BENEFIT REPORT, TRENDS AND FORECASTS, 1997 EDITION, NOVARTIS, EAST HANOVER, N.J.