Impact of formulary restrictions on medication use and costs

• Published in: The American journal of managed care Vol. 23; no. 8; p. e265
• Main Authors: Shen, Xian, Stuart, Bruce C, Powers, Christopher A, Tom, Sarah E, Magder, Laurence S, Perfetto, Eleanor M
• Format: Journal Article
• Language: English
• Published: United States MultiMedia Healthcare Inc 01.08.2017
• Subjects: Age Factors; Aged; Aged, 80 and over; Angiotensin II Type 1 Receptor Blockers - economics; Angiotensin II Type 1 Receptor Blockers - therapeutic use; Brand names; Costs; Diabetes Mellitus, Type 2 - drug therapy; Dipeptidyl-Peptidase IV Inhibitors - economics; Dipeptidyl-Peptidase IV Inhibitors - therapeutic use; Drug use; Drug Utilization - economics; Drugs, Generic - economics; Dyslipidemias - drug therapy; Female; Formularies as Topic; Generic drugs; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors - economics; Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use; Hypertension - drug therapy; Hypoglycemic Agents - economics; Hypoglycemic Agents - therapeutic use; Impact analysis; Low income groups; Male; Medicare; Medicare Part D - economics; Medicare Part D - organization & administration; Poverty - statistics & numerical data; Restrictions; United States
• ISSN: 1088-0224; 1936-2692; 1936-2692

To evaluate the effects of formulary restrictions on utilization and costs of oral hypoglycemic agents (OHAs), statins, and renin-angiotensin system (RAS) antagonists among low-income subsidy (LIS) recipients in Medicare Part D plans. We analyzed a 5% sample of 2012 Medicare data from the Chronic Conditions Data Warehouse together with a customized dataset capturing beneficiaries' histories of plan assignment. We constructed 3 nonexclusive study cohorts comprising of users of OHAs, statins, and RAS antagonists. Eligible study subjects were LIS recipients randomized to benchmark plans. Formulary restrictions of interest were noncoverage, prior authorization, and step therapy. Study outcomes included generic dispensing rate (GDR), mean cost per prescription fill, and medication adherence based on proportion of days covered (PDC). Random intercept regression models were performed to estimate the effects of formulary restrictions on the study outcomes by drug class. After covariate adjustment, beneficiaries who were subject to formulary restrictions on brand name pioglitazone and single-source brand name dipeptidyl peptidase-4 inhibitors (saxagliptin, sitagliptin, and sitagliptin-metformin) had a GDR 3 percentage points higher and a cost per prescription fill $10.8 less, but similar PDC compared with those who faced no restrictions. Restricting access to brand name atorvastatin and single-source brand name statins (rosuvastatin and ezetimibe-simvastatin) was associated with a GDR 14.9 percentage points higher and a cost per prescription fill $29.6 less, but with no impact on PDC. Restricting use of single-source brand name RAS antagonists (olmesartan, valsartan, and valsartan-hydrochlorothiazide) was associated with a GDR 15.0 percentage points higher, a cost per prescription fill $27.2 less, and a PDC 1.3 percentage points lower. Placing formulary restrictions on brand name drugs shifts utilization toward generic drugs, lowers the overall cost per prescription fill, and has minimal impact on overall adherence for OHAs, statins, and RAS antagonists among LIS recipients.