Although outcomes research is in its infancy stages, available data should be considered in the formulary selection process. A. Formulary decision makers make their selections on the basis of which drugs are considered to be the most effective treatment and least costly for most people. People are different, and patients with the same condition may react differently to the same drug. In closed formularies, the physician loses the ability to choose the drug he or she feels best fits the needs of each patient. The plan should have a process by which the treating physician may provide patients with non-formulary drugs, when deemed medically necessary by the prescribing physician.
Some patients are on complex regimens of numerous drugs.
Similar drugs can have very different effects and a change in only one prescription can result in adverse health consequences. Many health plans revise their formulary lists frequently, resulting in changes that the patient and his or her physician are not aware. Patients often learn of the change only when their pharmacist informs them, or when they pick up their prescription and notice the difference, which leaves insufficient time for appeal. California has passed a continuity of prescription drugs law. Some plans provide physicians with a monthly drug budget, financially penalizing them if they go over budget and rewarding them if they stay below budget.