Impact of a Uniform Formulary on Military Health System Prescribers Baseline Survey Results

by Tanielian, Terri; Harris, Katherine; Suarez, Ana; Labor, Renee; Bradley, Melissa

• ISBN13: 9780833033123
• ISBN10: 0833033123
• Format: Paperback
• Copyright: 2003-03-25
• Publisher: RAND Corporation

Summary

Assess Military Health System prescriber's experiences with, and opinions of, drug formularies.

Table of Contents

Preface	iii
Figures	ix
Tables	xi
Summary	xiii
Acknowledgments	xix
Acronyms and Abbreviations	xxi
Introduction	1	(4)
Study Background	5	(20)
Increasing Use and Cost of Pharmaceuticals	5	(2)
Increased Use of New Drugs	5	(1)
Increased Prescription Drug Benefits and Direct-to-Consumer Marketing	6	(1)
Management of Pharmaceutical Benefits	7	(2)
Therapeutic Switching or Substitution	8	(1)
Step-Therapy	8	(1)
Disease Management	8	(1)
Price Negotiation	9	(1)
Advantages and Disadvantages of Formulary Systems	9	(1)
Research on the Impact of Formulary Systems	10	(3)
The Department of Defense Pharmacy Programs	13	(6)
The Direct-Care System	15	(2)
The Purchased-Care System	17	(1)
The National Mail Order Pharmacy	18	(1)
Concerns About the Current System	19	(1)
The Structure of the Uniform Formulary Program	20	(2)
Access to and Availability of Pharmaceuticals	20	(1)
Cost-Sharing and the Three-Tier Co-Payment Structure	21	(1)
The Uniform Formulary Versus the Current System	21	(1)
Development and Maintenance of the Uniform Formulary	22	(1)
Surveys to Assess the Impact of the Uniform Formulary on Prescribers	23	(2)
Survey and Sample Design	25	(12)
Questionnaire Development	25	(2)
Direct-Care Prescribers' Questionnaire	25	(1)
Purchased-Care Prescribers' Questionnaire	26	(1)
Sampling Strategy	27	(10)
Direct-Care Prescribers' Sample Design	28	(3)
Purchased-Care Prescribers' Sample Design	31	(6)
Data Collection and Response Analysis	37	(6)
Data Collection for Direct-Care Prescribers	37	(1)
Data Collection for Purchased-Care Prescribers	38	(2)
Survey Response Status and Participation Rates	40	(1)
Analysis of Non-Response	40	(3)
Direct-Care Prescribers	41	(1)
Purchased-Care Prescribers	41	(2)
Summary of Findings	43	(32)
Analytic Approach	43	(4)
Definition of Stratification Variables	43	(1)
Sampling Weights	44	(3)
Statistical Tests	47	(1)
Prescriber Characteristics	47	(6)
Professional Characteristics	47	(1)
Practice Setting and Workload	48	(2)
Experience and Relationship with TRICARE (Purchased-Care Prescribers Only)	50	(3)
Prescribers' Familiarity and Experiences with Pharmacy Management Practices	53	(7)
Direct-Care Prescribers	53	(5)
Purchased-Care Prescribers	58	(2)
Impact of Pharmacy Management Practices on Prescribers' Clinical Practice	60	(3)
Attitudes About Impact of Formularies on Clinical Practice	62	(1)
Improving Compliance with Pharmacy Benefits	62	(1)
Attitudes on Effectiveness and Goals of Pharmacy Management Practices	63	(1)
Opinions on the Role and Effectiveness of P&T Committees	63	(2)
Impact of Non-Formulary Prescriptions Written Outside of MTFs (Direct-Care Prescribers Only)	65	(1)
Prescribers' Experiences with Obtaining Approval for Non-Formulary and Non-Preferred Drugs	66	(4)
Experiences with Making Requests for Non-Formulary Medications	67	(1)
Actions After Most-Recent Request Denial	67	(1)
Impact of Non-Formulary Request Denials on Patients' Health	68	(2)
Effects of Pharmacy Management and Direct-to-Consumer Marketing on Patient Behavior	70	(5)
Patients' Complaints About Drug Costs and Availability	70	(1)
Effects of Tiered Co-Payment Systems (Purchased-Care Prescribers Only)	71	(1)
Perceived Impact of Direct-to-Consumer Marketing	71	(2)
Perceptions of TRICARE Patients' Access to Pharmaceuticals (Purchased-Care Prescribers Only)	73	(1)
Prescribers' Write-In Comments	73	(2)
Conclusions	75	(110)
Study Limitations	75	(1)
Findings Regarding Direct-Care System Prescribers	76	(1)
Findings Regarding Purchased-Care System Prescribers	77	(1)
Comparing the Direct-Care and Purchased-Care Samples	78	(1)
Direct-Care and Purchased-Care Prescribers' Areas of Consensus	79	(1)
Status of Follow-Up Survey Effort	79	(2)
Appendix
A. Survey Materials for Direct-Care Prescribers	81	(22)
B. Survey Materials for Purchased-Care Prescribers	103	(24)
C. Coefficients and Odds Ratios Used in the Non-Response Analysis	127	(2)
D. Detailed Data on Survey Responses	129	(22)
E. Comments from Survey Respondents	151	(34)
References	185