Do the incentives in 3-tier pharmaceutical benefit plans operate as intended? Results from a physician leadership survey

William H. Shrank, Henry N. Young, Susan L. Ettner, Peter Glassman, Steven M. Asch, Richard L Kravitz

Research output: Contribution to journalArticle

43 Scopus citations

Abstract

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 "responsibilitz" 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.

Original languageEnglish (US)
Pages (from-to)16-22
Number of pages7
JournalAmerican Journal of Managed Care
Volume11
Issue number1
StatePublished - Jan 2005

ASJC Scopus subject areas

  • Nursing(all)
  • Medicine(all)
  • Health(social science)
  • Health Professions(all)

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