Formulary restrictions to reduce costs and use of prescription drugs may have unintended adverse consequences

Added May 9, 2020

Citation: Park Y, Raza S, George A, Agrawal R, Ko J. The effect of formulary restrictions on patient and payer outcomes: a systematic literature review. Journal of Managed Care & Specialty Pharmacy. 2017; 23(8): 893-901

What is this? The COVID-19 pandemic is placing a strain on healthcare services and resources. Existing research on the impact of formulary restrictions (restrictions to reduce costs and use of prescription drugs) for medications may provide information to help policy makers with this.

In this systematic review, the authors searched for research on the effects of formulary restrictions. They restricted their search to articles published in English between 2005 and February 2017. They included 48 retrospective observational studies, 5 time-series analysis studies, 3 cross-sectional studies, 1 case-control study, 1 controlled before-after study and 1 randomised trial.

What was found: Formulary coverage decisions may have unintended consequences on patient and payer outcomes, so there should be careful evaluation of restrictions before and after policy implementation, and it is uncertain which strategies might mitigate the unintended consequences.

Formulary restrictions reduced drug utilization and associated drug costs, but some of these cost savings were offset by increased healthcare resource use and medical costs.

Formulary restrictions were associated with reduced medication adherence and negative clinical outcomes in patients.


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