These latter factors may be particularly important, considering that the largest improvement in the proportion of subjects with adequate blood pressure control occurred between 2006 and 2007 following the implementation of both Medicare Part D insurance and WalMart's reduced-cost formulary, both in 2006.
Canadian policy makers expressed support for joint negotiations of PLAs in principle, citing benefits of increased bargaining power and reduced inter-jurisdictional inequities in drug prices and formulary listings.
Medication errors can be reduced by the use of a tool or drug formulary that summarizes information on commonly used drugs, their dosages and frequencies for use.
Although evidence suggests that the use of positive formulary lists reduces prescription rates in the short term, there is a lack of data regarding their long-term effects [ 16].
Patients and physicians may feel that the managed care system stresses the use of lower cost medications in its formulary and elsewhere [ 22, 23], and that patient out-of-pocket costs are unlikely to be reduced through medication switching.
Drug benefit plans may institute restrictive formularies or reduce coverage for new treatments, so seniors could get stuck with yesterday's medical technology.
In addition, the inclusion of lists of medications inappropriate for the elderly on national drug formularies would reduce their prescription and use in this age group [ 46].
(3) As other examples, Wellpoint developed an algorithm to search its database for patients with breast cancer with an intent to cancel their policies (4), while many insurers place all drugs used to treat such complex diseases as cancer, multiple sclerosis and HIV in the highest drug formulary cost-sharing tiers, thereby reducing insurers' costs but making the drugs unaffordable for many patients.
The authors concluded the system lacked advanced decision support rules in therapeutic error detection and a relevant hospital formulary database in order to reduce adverse events.
Researchers have warned that although formulary access restrictions are designed to reduce costs, '… if they cause a drop in patient persistence, or a flurry of activity (switching) with each new list that is adopted, there could be negative consequences for both patients and the Medicaid budget'[ 110].
Restricted use of specific antibiotics or antibiotic classes from the hospital formulary has been employed as a strategy to reduce the occurrence of antibiotic resistance and antimicrobial costs [ 21].
