Formulary limitations and the elderly: results from the Managed Care Outcomes Project

Area of Science:

• Health Services Research
• Pharmacoeconomics
• Geriatric Medicine

Background:

• Restrictive formularies are common strategies to control drug expenditures.
• The impact of these cost-containment measures on overall healthcare resource utilization is not fully understood.
• Potential variations in impact across different patient demographics, such as age, warrant investigation.

Purpose of the Study:

• To investigate the association between restrictive drug formularies and healthcare resource utilization.
• To determine if this association differs based on patient age.
• To analyze utilization across office visits, prescriptions, and hospitalizations.

Main Methods:

• Cross-sectional and longitudinal study design.
• Analysis of data from 12,997 patients across five diseases within six health maintenance organizations.
• Utilized severity-adjusted prescription counts, costs, office visit counts, and inpatient utilization measures.

Main Results:

• Significant positive associations were found between formulary limitations and healthcare resource utilization.
• These associations were notably stronger in elderly patients, even after controlling for illness severity.
• Increased utilization was observed across various metrics, including prescriptions and hospitalizations.

Conclusions:

• Strategies aimed at reducing drug costs through restrictive formularies may inadvertently increase overall healthcare resource utilization.
• The elderly population appears to be disproportionately affected by these increased utilization patterns.
• Further research is needed to balance cost-saving measures with patient outcomes and resource management.