More and more, providers and payers recognize that utilizing a total team approach where physicians, pharmacists, and other care givers work together to manage and coordinate a patient's care ultimately produces the best outcomes, which in turn is cost-effective. To pull any one piece out of the system without first making sure it works effectively with the other components is NOT the best way to manage and deliver care. Another weakness with the NPC report is that most of the studies cited focused on formularies in the hospital and Medicaid environments, not in the managed care setting, where care is generally delivered using a more integrated approach. And much of the data collected in the studies is outdated, occurring before 1990. We disagree strongly, however, with NPC's apparent categorical conclusion that all formularies fail to control costs and improve patient outcomes, because that's simply not the case.
Physicians have a lot of medical knowledge.
But even the best physicians cannot always keep up with all the medical literature that's out there. To deny those patients access to the more expensive drug when it's the appropriate therapy would not only compromise quality, but likely drive up costs in other parts of the system, because the patient will most likely need to receive additional follow up care. By the same token, just because one drug is more expensive than another drug does not necessarily mean it's the superior drug. This is a common misperception. One drug can be much less costly than another drug for the same condition, yet produce the same clinical outcomes for patients.