A formulary is just one of many tools used by managed care organizations and other providers to assure quality of care in a cost-effective manner. Formularies enhance patient care by essentially screening out those drugs which may not be as effective as others, or which may pose more adverse side effects for patients. Formulary decisions are made based on clinical data and experience. Cost also comes into play in cases where drugs are very similar. Your organization claims formularies don't work in a vacuum.
Formularies are important tools in assuring quality of care in a cost-effective manner.
But they work best when they are part of a larger system of integrated care. For example, in a well-managed pharmacy care program, pharmacists and other care givers will perform drug utilization review and drug use evaluation. These tools allow care givers to identify situations in which patients and prescribers may be inappropriately using medications. For example, we know from our members of situations where some patients prescribed particular painkillers or other prescription agents have become addicted to the drugs. Another example would be if plan that determines from looking at its pharmacy and medical claims data that patients on one brand of drug for asthma were more likely to have more visits to the emergency room for asthma than asthma patients prescribed a different brand of medication.