In other words, the goal of formulary management is superior therapeutics. Drug formularies have been a part of managed care pharmacy benefits from the beginning. Restricted formularies, sometimes referred to as modified formularies, have become more commonplace in recent years, and so have variations of benefit designs used in conjunction with those formularies. A restricted formulary involves limiting drug classes to listing only generics or only one of each chemical structure medication within a drug class. These restricted lists may be coupled with a benefit design which places more of a financial burden on the patient when a brand name drug is chosen or a drug not included on the list is prescribed.
Closed designs can vary significantly based on the number of drugs included on the formulary.
A formulary listing over 1500 medications will have a significantly different impact on the HMO, prescribers or patients than a formulary listing 600 medications. These lists and designs are described by reimbursement limited to a formulary of drugs plus select non-formulary drugs once prior approval has been granted. This possibly more friendly approach will likely gain popularity due to managed care competition and the need to be more customer focused. In summary, well constructed formulary systems developed through a close partnership between pharmacists and physicians, continue to play an integral role in the provision of cost effective pharmaceutical care. A wide variation exists among managed care organization's fomulary lists and the pharmacy benefit designs used in conjunction with those lists.