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.

Managed Care’s Top Ten Articles of 2016

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Shelley Slade
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