Weighing the Evidence

Trends in Managed Care Formulary Decision Making

Gregory De Lissovoy

Research output: Contribution to journalArticle

Abstract

Health plans, pharmacy benefit managers, and other organizations use drug formularies to promote quality care while controlling costs. However, restrictive formularies are often viewed as constraints on physician practice and potential barriers to optimal patient care. Reluctance to add new drugs to an established formulary is rational economic behavior. Innovative compounds may have unknown properties with uncertain outcomes and therefore may impose costs in the form of risk. Products that seemingly duplicate drugs already on formulary may increase transaction costs without additional benefit. In evaluating new products, formulary managers face the task of identifying, assembling, and synthesizing a wide range of complex information. Manufacturers, who may be in the best position to supply that information, have been severely restricted by U.S. Food and Drug Administration (FDA) regulations that limited marketing communications to findings from well-controlled clinical trials. The FDA Modernization Act of 1997 eased these restrictions somewhat by acknowledging that sophisticated purchasers such as organized health plans were capable of weighing the quality and impartiality of manufacturer-supplied evidence. The Academy of Managed Care Pharmacy (AMCP) created a standardized template that formularies can use to request comprehensive information about specific drugs from manufacturers. Widespread adoption of the AMCP format by health plans and manufacturers will greatly increase access to information about new drugs, speeding the process of formulary committee deliberation, and instilling greater confidence in the outcome of those decisions. Wider access to new drugs may result.

Original languageEnglish (US)
Pages (from-to)29-32
Number of pages4
JournalJournal of Clinical Psychiatry
Volume64
Issue numberSUPPL. 17
StatePublished - 2003

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Formularies
Managed Care Programs
Decision Making
Pharmaceutical Preparations
Costs and Cost Analysis
Health
Pharmacy and Therapeutics Committee
Access to Information
Quality of Health Care
Drug and Narcotic Control
Controlled Clinical Trials
United States Food and Drug Administration
Marketing
Social Change
Patient Care
Communication
Economics
Organizations
Physicians
Food

ASJC Scopus subject areas

  • Psychiatry and Mental health
  • Clinical Psychology

Cite this

Weighing the Evidence : Trends in Managed Care Formulary Decision Making. / De Lissovoy, Gregory.

In: Journal of Clinical Psychiatry, Vol. 64, No. SUPPL. 17, 2003, p. 29-32.

Research output: Contribution to journalArticle

De Lissovoy, Gregory. / Weighing the Evidence : Trends in Managed Care Formulary Decision Making. In: Journal of Clinical Psychiatry. 2003 ; Vol. 64, No. SUPPL. 17. pp. 29-32.
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