BACKGROUND: Three-tier pharmaceutical benefit systems use graded co-payments to steer patients toward "preferred" formulary medications. OBJECTIVES: To evaluate physicians' knowledge of formularies and out-of-pocket costs in such systems, as well as their perceived responsibility for helping patients manage out-of-pocket costs. STUDY DESIGN: Self-administered written survey. METHODS: Physician leaders participating in the California Medical Association Leadership Conference were surveyed. RESULTS: A total of 133 responses were received from 205 participants (65% response rate). Physicians reported that they were often unaware of patients' out-of-pocket costs at the time of prescribing. Fifty-nine percent of physicians reported that they never or seldom were aware of patients' "preferred" (lower cost) formulary options when prescribing, and 70% never or seldom were aware of patients' out-of-pocket costs when prescribing. Although 88% of physicians agreed that it is important that patients' out-of-pocket costs for prescription drugs are managed, only 25% strongly or somewhat agreed that it is their "responsibility" to help. Instead, 69% of physicians believed that it is the responsibility of the pharmacist to be familiar with patients' out-of-pocket costs. Physicians reported that they receive phone calls from pharmacists concerning formulary issues after 18.6% of the prescriptions they write. CONCLUSIONS: Physician leaders reported that they often do not possess the knowledge to assist patients in managing out-of-pocket costs for prescription drugs and they depend on pharmacists to communicate patient preferences in making prescribing decisions. As a result, price preferences are communicated indirectly, likely less efficiently, rather than intentionally when prescribing decisions are made.
BACKGROUND: Three-tier pharmaceutical benefit systems use graded co-payments to steer patients toward "preferred" formulary medications. OBJECTIVES: To evaluate physicians' knowledge of formularies and out-of-pocket costs in such systems, as well as their perceived responsibility for helping patients manage out-of-pocket costs. STUDY DESIGN: Self-administered written survey. METHODS: Physician leaders participating in the California Medical Association Leadership Conference were surveyed. RESULTS: A total of 133 responses were received from 205 participants (65% response rate). Physicians reported that they were often unaware of patients' out-of-pocket costs at the time of prescribing. Fifty-nine percent of physicians reported that they never or seldom were aware of patients' "preferred" (lower cost) formulary options when prescribing, and 70% never or seldom were aware of patients' out-of-pocket costs when prescribing. Although 88% of physicians agreed that it is important that patients' out-of-pocket costs for prescription drugs are managed, only 25% strongly or somewhat agreed that it is their "responsibility" to help. Instead, 69% of physicians believed that it is the responsibility of the pharmacist to be familiar with patients' out-of-pocket costs. Physicians reported that they receive phone calls from pharmacists concerning formulary issues after 18.6% of the prescriptions they write. CONCLUSIONS: Physician leaders reported that they often do not possess the knowledge to assist patients in managing out-of-pocket costs for prescription drugs and they depend on pharmacists to communicate patient preferences in making prescribing decisions. As a result, price preferences are communicated indirectly, likely less efficiently, rather than intentionally when prescribing decisions are made.
Authors: William H Shrank; Sarah A Fox; Adele Kirk; Susan L Ettner; Clairessa H Cantrell; Peter Glassman; Steven M Asch Journal: J Gen Intern Med Date: 2006-04 Impact factor: 5.128
Authors: Henry N Young; Robert A Bell; Ronald M Epstein; Mitchell D Feldman; Richard L Kravitz Journal: J Gen Intern Med Date: 2006-11 Impact factor: 5.128
Authors: William H Shrank; Margaret Stedman; Susan L Ettner; Dee DeLapp; June Dirstine; M Alan Brookhart; Michael A Fischer; Jerry Avorn; Steven M Asch Journal: J Gen Intern Med Date: 2007-07-24 Impact factor: 5.128
Authors: William H Shrank; Suzanne M Cadarette; Emily Cox; Michael A Fischer; Jyotsna Mehta; Alan M Brookhart; Jerry Avorn; Niteesh K Choudhry Journal: Med Care Date: 2009-03 Impact factor: 2.983