Chief Science Policy Officer, Global Healthy Living Foundation Senior Health Policy Fellow, Progressive Policy Institute and Visting Health Policy Fellow, Pioneer Institute, United States
Research Article
Analysis of Drug Formulary Exclusions from the Patient's Perspective
Author(s): Robert Popovian*, Anne M. Sydor and Peter Pitts
Objective: Pharmacy benefit management companies (PBMs) often determine medication reimbursement with formularies, which were initially intended to ensure use of the least-costly still effective medication. Today, formularies are designed to maximise concessions (ie, rebates and fees) from PBMs through the biopharmaceutical industry. Exclusions may no longer benefit patients by controlling costs, but rather serve to enhance the ability to drive the amount gained through rebate contracting. In this brief report, we evaluate excluded drugs on the only national formulary that is publicly available in the US from the perspective of whether or not the exclusions benefit patients.
Methods: We analysed exclusions of the 2022 national formulary of the second-largest PBM in the US that is publicly available. We categorised substitutions as equivalent.. View More»
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