Arkansas, Connecticut, and Texas instituted such measures in 1999, joining California, Tennessee, and Rhode Island. The third type restricts generic substitutions for specific brand medications, a micro-management approach that has fallen out of favor with government. No states have gone this route since 1997, when three experimented with it. Gosfield counters that every doctor has an anecdote in which a formulary drug didn't perform as well for a specific patient. While doctors realize the value of cost containment, they will always advocate for their patients' needs, she adds.
Most friction probably stems from a difference in perspective.
Health plans are responsible for populations of patients, and make their decisions based on actuarial data. That clash of cultures can lead to disappointed expectations. All rights reserved.