The patient had responded so well to Wellbutrin that he was able to return to work after being ill. Making a substitution to the prescription could have jeopardized this man's progress, Pinheiro said. That's the official list of prescription medications that are approved for reimbursement under a health plan. Drugs get added or subtracted to a formulary based on how their effectiveness is rated in general studies in medical literature. Broad studies cannot account for how effectiveness may vary in individual cases.
Most companies make changes to their formularies on a quarterly basis.
A team of physicians and pharmacists assesses new medications available and evaluates entire drug classes using peer-reviewed journals. In the case that Pinheiro described, the problem was that the insurer should have notified the patient that there had been a change in the formulary. Motheral also explained a possible reason for this particular patient's medication being dropped from the formulary. The slow-release form of Wellbutrin is becoming popular for smoking cessation, raising the cost of the drug. The insurer would have to be informed that this man needed it to treat his depression in order to restore coverage.