Issues in the Design and Implementation of Drug Formularies and Therapeutic Classes

Final Report

Contents

Project Team
Executive Summary (in PDF Format)

Chapters

1. Introduction (in PDF format)
2. Classification Systems and Formularies (in PDF format)
   • Background
   • Methodology
   • Role, Structure, and Content of Classification Systems
   • The P&T Committee Process
   • Policy Implications: Classification Systems, Formularies, and P&T committees
3. The USP Classification System (in PDF format)
   • Background: How does the USP Classification System Work?
   • Policy Implications: The USP System
4. The CMS Rules for Formularies (in PDF format)
   • Background: How do the CMS Formulary Rules Work?
   • Coverage of Commonly Used Drugs Under CMS Rules
   • Policy Implications: Adequacy of Coverage Under the CMS Rules
   • Would "Real World" formularies meet CMS Rules?
   • Policy Implications: Will "Real World" Formularies Pass the CMS Tests?
5. Formulary Analysis Model (in PDF format)
   • Background
   • The Methodology: The Formulary Simulation Model
   • Prototype Formularies in the Model
   • Policy Implications: Analyzing Prototype Formularies
   • "Real World" Formularies in the Modes
   • Policy Implications: Potential for Risk Selection
   • Potential for Refining the Model
6. Conclusions and Possible future Research (in PDF format)

Appendices

• Classification Systems and Formularies
• Appendix A: Tables describing classification systems and formularies
• Appendix B: Crosswalks showing drugs as classified by different systems
• Appendix C: Information from plan interviews
• USP Classification System and CMS Rules
  • Appendix D: MCBS utilization by USP class and category
  • Appendix E: Commonly used drugs
  • Appendix F: Do “real world” formularies meet CMS tests?
• Formulary Analysis Model
  • Appendix G: Additional information on elasticity
  • Appendix H: Elasticity panel members
  • Appendix I: Additional information on model
  • Formulary Simulation Model

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Last updated: 01/31/06