Fixed and flexible formularies as cost-control mechanisms

Expert Review of Pharmacoeconomics and Outcomes Research

Volumn 3, Issue 3, 2003, Pages 303-315

  Dewa, Carolyn S ^a   Hoch, Jeffrey S ^b  

^a CENTRE FOR ADDICTION AND MENTAL HEALTH   (Canada)

^b UNIVERSITY OF WESTERN ONTARIO   (Canada)

Author keywords

Cost containment; Fixed formulary; Flexible formulary; Prescription drug benefits

Indexed keywords

CALCIUM CHANNEL BLOCKING AGENT; DIHYDROPYRIDINE DERIVATIVE; DIPEPTIDYL CARBOXYPEPTIDASE INHIBITOR; FLUOXETINE; GENERIC DRUG; HISTAMINE H2 RECEPTOR ANTAGONIST; NONSTEROID ANTIINFLAMMATORY AGENT; PAROXETINE; SERTRALINE; SILDENAFIL;

COST CONTROL; DECISION MAKING; DRUG COST; DRUG FORMULARY; DRUG MARKETING; DRUG USE; ECONOMIC ASPECT; FINANCIAL MANAGEMENT; HUMAN; INFORMATION PROCESSING; PATIENT CARE; PHARMACEUTICAL CARE; PRESCRIPTION; PROSPECTIVE PRICING; REVIEW; RISK ASSESSMENT;

EID: 0038680398     PISSN: 14737167     EISSN: None     Source Type: Journal    
DOI: 10.1586/14737167.3.3.303     Document Type: Review

References (51)

1. Kleinke JD. Just what the HMO ordered: the paradox of increasing drug costs. Health Affairs 19(2), 78-91 (2000).
2. Chernew M, Cowen ME, Kirking DM, Smith DG, Valenstein P, Fendrick AM. Pharmaceutical cost growth under capitation: a case study. Health Affairs 19(6), 266-276 (2000).
3. Levitt K, Cowan C, Braden B, Stiller J, Sensenig A, Lazenby H. National health expenditures in 1997: more slow growth. Health Affairs 17(6), 99-110 (1999).
4. Anis AH. Substitution laws, insurance coverage, and generic drug use. Med. Care 32(3), 240-256 (1994).
5. Motheral BR, Henderson R. The effect of a closed formulary on prescription drug use and costs. Inquiry 36, 481-491 (1999).
6. Grabowski H, Mullins CD. Pharmacy benefit management, cost-effectiveness analysis and drug formulary decisions. Soc. Sci. Med. 45(4), 535-544 (1997).
7. Olmstead T, Zeckhauser R. The menu-setting problem and subsidized prices: drug formulary illustration. J. Health Econ. 18, 523-550 (1999).
8. Dranove D, White WD. Agency and the organization of health care delivery. Inquiry 24, 405-415 (1987).
9. Sloan FA, Gordon GS, Cocks DL. Hospital formularies and use of hospital services. Med Care 31(10), 851-867 (1993).
10. Leibowitz A, Manning WG, Newhouse JP. The demand for prescription drugs as a function of cost-sharing. Soc. Sci. Med. 21(10), 1063-1069 (1985).
11. Foxman B, Valdez RB, Lohr KN, Goldberg GA, Newhouse JP, Brook RH. The effect of cost sharing on the use of antibiotics in ambulatory care: results from a population-based randomized controlled trial. J. Chron. Dis. 40(5), 429-437 (1987).
12. Soumerai SB, Ross-Degnan D, Fortess EE, Abelson J. A critical analysis of studies of state drug reimbursement policies: research in need of discipline. Milbank Qrtly. 71(2), 217-252 (1993).
13. Lexchin J. Effects of restrictive formularies in the ambulatory care setting. Am. J. Man. Care 8(1), 69-76.
14. Schweitzer SO, Shiota SR. Access and cost implications of state limitations on Medicaid reimbursement for pharmaceuticals. Ann. Rev. Pub. Health 13, 399-410 (1992).
15. Moore WJ, Newman RJ. Drug formulary restrictions as a cost-containment policy in Medicaid programs. J. Law Econom. 36 (April), 71-97 (1993).
16. Lewis JH, Schonlau M, Muñoz JA. Compliance among pharmacies in California with a prescription-drug discount program for Medicare beneficiaries. N. Eng. J. Med. 346(11), 830-835 (2002).
17. Spigset O, Mårtensson B. Drug treatment of depression. Brit. Med. J. 318, 1188-1191 (1999).
18. Gorecki PK. A comparison of two drug reimbursement pricing models: B.C. Pharamcare and the Ontario Drug Benefit Programme. Can. J. Econ. 26(4), 867-877 (1993).
19. Anis, AH. Pharmaceutical prices with insurance coverage and formularies. Can. J. Econ 25(2), 420-437 (1992).
20. Spino M, Tsang YC, Pop R. Dissolution and in vivo evidence of differences in reference products: impact on development of generic drugs. Eur. J. Drug Metab. Pharmacokinetics 25 (1), 18-24 (2000).
21. Lindsey R. West DS. National pharmacare, reference based pricing and drug R&D: a critique of the national forum on healths recommendations for pharmaceutical policy. Can. Pub. Policy XXV(1), 1-27 (1999).
22. Dickson M. The pricing of pharmaceuticals: an international comparison. Clin. Therapeutics 14(4),604-610 (1992).
23. Selke GW. Reference price systems in the European community. In: Cost Containment Pricing Financing of Pharmaceuticals in the European Community: Policymaker's View. Mossialos E, Ranos C, Abel-Smith B (Eds). LSE Health and Pharmetrica SA., London, UK (1994).
24. Scott A. Reference pricing: a sham and a shambles. In: Healthy Incentives: Canadian Health Reform in an International Context. McArthur WJ, Ramsay C, Walker M (Eds). The Fraser Institute, Vancouver, Canada, 91-99 (1996).
25. Moore D, Scott A. The great debate about reference pricing of pharmaceuticals. In: Healthy Incentives: Canadian Health Reform in an International Context. McArthur WJ, Ramsay C, Walker M (Eds). The Fraser Institute, Vancouver, Canada, 103-108 (1996).
26. Ulrich V, Wille E. Healthcare reform and expenditure on drugs. PharmacoEconomics 10(Suppl. 2), 81-88 (1996).
27. Bosanquet N, Zammit-Lucia J. The effect of competition on drug prices. PharmacoEconomics 8(6), 473-478 (1995).
28. Schneeweiss S, Schöffski O, Selke GW. What is Germanys experience on reference based drug pricing and the etiology of adverse health outcomes or substitution? Health Policy 44, 253-260 (1998).
29. Bourgault C, Elstein E, Le Lorier J, Suissa S. Reference-based pricing of prescription drugs: exploring the equivalence of angiotensin-converting-enzyme inhibitors. Can. Med. Assoc. J 161, 255-260 (1999).
30. Grootendorst P, Holbrook A. Evaluating the impact of reference based pricing. Can. Med. Assoc. J. 161, 273-274 (1999).
31. Narine L, Senathirajah M, Smith T. Evaluating reference-based pricing: initial findings and prospects. Can. Med. Assoc. J. 161, 286-288 (1999).
32. Kent H. BC's reference-based pricing stirs controversy. Can. Med. Assoc. J. 162, 1190 (2000).
33. Schneeweiss S, Walker AM, Glynn RJ, Maclure M, Dormuth C, Soumerai SB. Outcomes of reference drug pricing for angiotensin-converting enzyme inhibitors. N. Eng. J Med. 346, 822-829 (2002).
34. Schneeweiss S, Soumerai SB, Glynn RJ, Maclure M, Dormuth C, Walker AM. Impacts of reference pricing for ACE inhibitors on drug utilization. Can. Med. Assoc. J. 166, 737-748 (2002).
35. Morgan S. Quantifing components of drug expenditure inflation: the British Columbia Seniors Drug Benefit Plan. Health Services Res. 37, 1243-1266 (2002).
36. Tamblyn R, Laprise R. Hanley JA et al. Adverse events associated with prescription drug cost-sharing among poor and elderly persons. JAMA 285, 4421-429 (2001).
37. Soumerai SB, Avorn J, Ross-Degnan D, Gortmaker S. Payment restrictions for prescription drugs in Medicaid: effects on therapy, cost and equity. N Eng. J. Med. 317, 550-556 (1987).
38. Anis A. Why is calling an ACE and ACE so controversial? Evaluating reference-based pricing in British Columbia. Can. Med. Assoc. J. 166,763-764 (2002).
39. Schneeweiss S, Maclure M, Walker AM, Grootendorst P, Soumerai SB. On the evaluation of drug benefits policy changes with longitudinal claims data: the policy maker's versus the clinician's perspective. Health Policy 55, 97-109 (2002).
40. Segedin DA. Three-tier copayment plans: design considerations and effectiveness. Drug Benefit Trends 11 (9), 43-52 (1999).
41. Freemantle N, Bloor K. Lessons from international experience in controlling pharmaceutical expenditure. I: Influencing patients. Brit. Med. J 312, 1469-1471 (1996).
42. Manning WG, Newhouse JP, Duan N, Keeler EB, Leibowitz A, Marquis MS. Health insurance and the demand for medical care: evidence from a randomized experiment. Am. Econom. Rev. 77(3), 251-277, (1987).
43. Reeder CE, Nelson AA. The differential impact of copayment on drug use in a Medicaid population. Inquiry 22, 396-403 (1985).
44. Harris BL, Stergachi A, Ried LD. The effect of drug copayments on utilization and cost of pharmaceuticals in a HMO. Medical Care 28(10), 907-917 (1990).
45. Newhouse JP. Free For All? Lessons from the RAND Health Insurance Experiment. Harvard University Press, Cambridge, USA (1993).
46. Hillman A, Pauly M, Escarce J et al. Financial incentives and drug spending in managed care. Health Affairs 18(2), 189-200, (1999).
47. Latimer EA, Tamblyn R, Laprise R et al. Net economic impact of a reduction in drug insurance coverage for mentally ill welfare recipients in Québec. Working Paper. Douglas Hospital Research Centre. (1999).
48. Motheral B, Fairman KA. Effect of a three-tier prescription copay on pharmaceutical and other medical utilization. Medical Care 39(12), 1293-1304 (2001).
49. National Institute for Health Care Management Research and Educational Foundation (NIHCM). A primer: generic drugs, patents and the pharmaceutical marketplace. A forthcoming report, 1-28 (2002).
50. Carroll NV, Fincham JE, Cox FM. The effects of differences in state drug product selection laws on pharmacists' substitution behavior. Med. Care 25(11), 1069-1077 (1987).
51. Lipton HL, Kreling DH, Collins T, Hertz KC. Pharmacy benefit management companies: dimensions of performance. Ann. Rev. Pub. Health 20, 361-401 (1999).