The final decision on prescriptions is always up to the physician. Formulary limits choices These days, though, doctors' choices of prescription drugs are constrained by formularies. Large PBMs can end up administering dozens of drug lists. Closed formularies are becoming less common because both doctors and patients find them too restrictive, according to PBM executives. Instead of five or six medications for cholesterol, you have only two.
Formularies can also lead to disruptions at the doctor's office.
In a typical scenario, a patient goes to the pharmacy to get a prescription filled, only to be told that the drug isn' t covered by his or her health plan. The pharmacist calls the doctor to see if there's an acceptable substitute. That kind of call can't be ignored or postponed, Dr. Malinowski said. The more health plans doctors are signed up with, the more such calls they get. You have to make a change in the prescription and change in the chart.