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Given the shifting reimbursement landscape, health systems are exploring new shared-risk contracting models as well as technology based solutions to implement their own distinct medication formularies and medication access models.
They looked at how often drugs were included in at least 90% of formularies at copayments of $35 or less without prior authorization.
White, a spokesperson for the American Association of Health Plans, formerly known as the Group Health Association of America, said while the study showed a relationship between restrictive formularies and use of medical services, it was flawed in that it did not look at the cause of the patients' recurring illnesses.
In addition, Hospital Formulary Insights: Anti-Thrombotics provides information on the formulary status and restriction status of key anticoagulant, antiplatelet and thrombolytic brands and why drugs are or are not included on hospital formularies.
CMS will review formularies to ensure the adequacy of the benefit offered, regardless of whether plans adopt the model guidelines set by USP, Mr.
The report also found that 62 percent of surveyed pharmacy directors expect their MCO to reimburse Boehringer Ingelheim's olodaterol/tiotropium on either their dominant commercial or Medicare formularies upon its anticipated launch in 2013.
As the price for asthma and COPD drugs increases and competition among therapies grows, more plans will consider tightened formularies and formulary exclusion," said HealthLeaders-InterStudy Analyst Roy Moore, author of the report.
Even at the lowest price surveyed, 15 percent of surveyed pharmacy directors say they will exclude the drug from their formularies.
The report also finds that Novartis/Mitsubishi Tanabe Pharma's Gilenya (fingolimod) - which launched in October 2010 - had only 47 percent of commercial plans including the first oral therapy on their formularies by January 2011.
At the same price point on their Medicare plans, surveyed pharmacy directors are evenly split as to whether they would reimburse Prolia as a Tier 3 or 4 benefit, but 34 percent of surveyed pharmacy directors say their managed care organization would not include Prolia on their Medicare formularies at this price.
Formulary Compass[TM] is a comprehensive collection of over 5,000 plan and organization specific formularies, including all State Medicaid and Medicare Part D formularies.