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Are Medicaid Closed Formularies Unethical?
1An associate program officer at the National Academies of Sciences, Engineering, and Medicine in Washington, DC.
AMA Journal of Ethics
|August 10, 2019
Summary
State Medicaid programs use closed formularies to control drug spending. While these can fund other social goals, public input is vital for fair formulary design, especially for vulnerable patients.
Area of Science:
- Health Policy
- Public Health
- Health Economics
Background:
- State Medicaid programs are exploring closed formularies to manage drug expenditures.
- Closed formularies are proposed as a cost-saving measure within state healthcare programs.
- The use of formularies raises concerns about drug access and equity.
Purpose of the Study:
- To examine criticisms of Medicaid closed formularies regarding limited deliberation and potential disadvantage to low-income patients.
- To assess the justification and public involvement in designing drug formularies.
- To compare fairness issues in Medicaid closed formularies with private insurance practices.
Main Methods:
- Analysis of criticisms concerning Medicaid closed formularies.
- Examination of decision-making processes for formulary design.
- Comparative review of closed formulary implementation in Medicaid versus private insurance.
Main Results:
- Criticisms suggest Medicaid closed formularies may restrict discussion on drug access decisions.
- There is a risk that closed formularies could unfairly impact impoverished patients.
- Similar fairness concerns exist with closed formularies in private insurance plans.
Conclusions:
- Justification for closed formularies requires demonstrating benefits for other social aims.
- Public deliberation is essential for equitable formulary design.
- The potential for unfairness to vulnerable populations is a shared challenge across different insurance types.
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