Modeling the Effects of Formulary Exclusions: How Many Patients Could Be Affected by a Specific Exclusion?

ABSTRACT: Background: Medication formularies, initially designed to promote the use of cost-effective generic drugs, are now designed to maximize financial benefits for the pharmacy benefit management companies that negotiate purchase prices. In the second-largest pharmacy benefit management formulary that is publicly available, 55% of mandated substitutions are not for generic or biosimilar versions of the same active ingredient and/or formulation and may not be medically or financially beneficial to patients. Methods: We modeled the effect of excluding novel agents for atrial fibrillation/venous thromboembolism, migraine prevention, and psoriasis, which all would require substitution with a different active ingredient. Using population data, market share of the 2 largest US formulari

SUBMITTER: Sydor AM 

PROVIDER: S-EPMC10970716 | biostudies-literature | 2024

REPOSITORIES: biostudies-literature