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Patients shouldn't be penalized by their biology if they need a drug that isn't on formulary.
Information on formulary comparisons using differential features tables.
In light of its potential breakthrough status, I suspect the vast majority of payers will place esketamine on formulary.
†Ciprofloxacin on formulary but no respiratory fluoroquinolone on formulary.
The fluoroquinolones on formulary are ciprofloxacin and moxifloxacin.
The introduction of new agents on formulary may provide an improvement in clinical options but often further complicates prescribing practice.
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Jacobs and Sommers analyzed the placement of NRTIs on formularies for 48 plans in 12 states using the federally facilitated insurance marketplaces, and found evidence of adverse tiering in 25% of plans.
"Unless you can demonstrate clinical benefit, I think increasingly it's going to be very difficult to get on formularies unless you're willing to offer a deeply discounted price," he said, referring to lists of drugs approved by health care providers.
Resolving this issue by specifying exactly which drugs have to be on formularies and how they should be covered, however, would unlikely provide an optimal policy solution and may indeed make obsolete the idea of achieving efficiency gains through insurer competition.
Preferred placement on formularies leads to costlier coverage, due to higher utilization of costlier drugs.
In September, two of my favorite health care think-tankers acknowledged in the Wall Street Journal that "manufacturers offer rebates for preferred placement" on formularies, but then surmised incorrectly that "a ban on rebates would make coverage more expensive and less generous," when the opposite is true.
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Justyna Jupowicz-Kozak
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