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    Do drug formulary policies reflect evidence of value

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    Authors
    Neumann, Peter J.
    Lin, Pei-Jung
    Greenberg, Dan
    Berger, Marc
    Teutsch, Steven M.
    Mansley, Edward
    Weinstein, Milton C.
    Rosen, Allison B.
    UMass Chan Affiliations
    Department of Quantitative Health Sciences
    Document Type
    Journal Article
    Publication Date
    2006-01-13
    Keywords
    Boston
    Cost Savings
    Cost-Benefit Analysis
    Decision Making, Organizational
    Deductibles and Coinsurance
    Drug Costs
    Evidence-Based Medicine
    Florida
    Formularies as Topic
    *Health Policy
    Health Services Needs and Demand
    Humans
    Insurance Coverage
    Insurance, Pharmaceutical Services
    Medicaid
    Organizational Policy
    Outcome Assessment (Health Care)
    Patient Selection
    Pharmacy and Therapeutics Committee
    Quality-Adjusted Life Years
    Registries
    Reimbursement, Incentive
    Biostatistics
    Epidemiology
    Health Services Research
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    Link to Full Text
    http://www.ajmc.com/issue/managed-care/2006/2006-01-vol12-n1/Jan06-2245p30-36
    Abstract
    OBJECTIVE: To investigate the extent to which preferred drug lists and tiered formularies reflect evidence of value, as measured in published cost-utility analyses (CUAs). METHODS: Using 1998-2001 data from a large registry of cost-effectiveness analyses, we examined the 2004 Florida Medicaid preferred drug list and the 2004 Harvard Pilgrim Pharmacy Program 3-tier formulary, and compared cost-utility ratios (standardized to 2002 US dollars) of drugs with preferred and nonpreferred status. RESULTS: Few drugs on the formularies had any cost-utility data available. Of those that did, median cost-utility ratios were somewhat higher (less favorable) for Florida's preferred drugs compared with the nonpreferred drugs (25,465 dollars vs 13,085 dollars; P = .09). Ratios did not differ for drugs on tiers 1 and 2 of the Harvard Pilgrim formulary, although they were higher for tier 3 and for excluded drugs (18,309 dollars, 18,846 dollars, 52,119 dollars, and 22,580 dollars, respectively; P = .01). Among therapies reported to be cost-saving or to have cost-utility ratios below 50,000 dollars, 77% had favored status in Florida Medicaid and 73% in Harvard Pilgrim. Among dominated drug interventions (reported to be more costly and less effective than alternatives), 95% had favored status in Florida Medicaid and 56% in Harvard Pilgrim. CONCLUSIONS: This study underscores the paucity of published cost-utility data available to formulary committees. Some discrepancies prevail between the value of drugs, as reflected in published cost-utility ratios, and the formulary placement policies of 2 large health plans.
    Source
    Am J Manag Care. 2006 Jan;12(1):30-6.
    Permanent Link to this Item
    http://hdl.handle.net/20.500.14038/47785
    PubMed ID
    16402886
    Related Resources
    Link to Article in PubMed
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    Population and Quantitative Health Sciences Publications

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