Access and Utilization of New Antidepressant and Antipsychotic Medications. B. Formularies


The four provider and consumer associations interviewed reported that formularies are no longer impeding access to newer psychotherapeutics. All four associations have witnessed a diffusion of new drugs, namely the newer generation antidepressants and antipsychotics, in the market.

The manufacturers interviewed concurred, reporting that formulary access either under fee-for-service arrangements or in hospital settings was a problem of the past. Manufacturers believed psychotropics to be regarded differently than physical drugs, both favorably and unfavorably. Specifically, an informant from one manufacturer thought formulary approval was easier or faster for psychotropics due to high visibility and publicity of extreme cases and political pressure (e.g., from consumer and advocacy groups). Manufacturers approach to formulary access appears to be advocating broad class coverage, even as they work to achieve "preferred" status for their own product where possible by demonstrating superior effectiveness or cost-effectiveness.

The concept of "open, closed, or restricted" formulary is changing in meaning. A closed formulary generally means that non-formulary medications will not be reimbursed. Often, however, closed formularies allow non-formulary drugs to be reimbursed if prior authorization is obtained. A 1997 survey indicated that only 19% of closed formularies did not allow physicians to override formulary restrictions.21,22,23 However, plans with closed formularies may also impose monetary penalties on physicians who routinely prescribe non-formulary medications.

The use of "preferred" drug lists, whereby physicians are encouraged, but not required, to prescribe a particular drug is also growing, and may be replacing the traditional formulary. In 1995, 70% of HMOs maintained preferred pharmaceutical lists, while 83% did so in 1998. Often patients receiving a non-preferred drug are required to pay a higher co-payment (39.1% of plans in 1995, 71.7% of plans in 1998).24