Tootelian D H, Gaedeke R M
California State University, Sacramento 95810.
Health Mark Q. 1991;8(3-4):193-207. doi: 10.1300/J026v08n03_11.
Efforts to control the rising costs of drug budgets has centered primarily on the use of "closed formularies"--systems in which a set of drug products are pre-approved for dispensing to those eligible for expense coverage. Controversy, however, has surrounded these systems with respect to their effectiveness in controlling costs and their impacts on the quality of care for recipients. This study examined California physician attitudes towards the California Medicaid program's use of a closed formulary and treatment authorizations which must be obtained in order to dispense drugs not on the Medi-Cal pre-approved list. A survey of physicians focused on the extent to which they sought to use non-formulary medications, their experience with formulary products that were not their drugs of choice, and the extent to which the overall system impacted their practices. Results of the survey indicated that the closed formularly discouraged physicians from dispensing drugs of choice. Furthermore, physicians often experienced adverse or sub-therapeutic results with formulary medications that they would not have expected had they dispensed their preferred medications.
控制药品预算不断上涨的成本的努力主要集中在使用“封闭式处方集”——在这些系统中，一组药品预先获得批准，可供符合费用覆盖条件的人配药。然而，这些系统在控制成本方面的有效性以及对接受者护理质量的影响一直存在争议。本研究调查了加利福尼亚州医生对加利福尼亚医疗补助计划使用封闭式处方集和治疗授权的态度，为了配给不在医疗补助预先批准名单上的药物，必须获得治疗授权。一项针对医生的调查重点关注他们寻求使用非处方药物的程度、他们对非首选的处方集产品的使用体验，以及整个系统对他们行医的影响程度。调查结果表明，封闭式处方集阻碍医生配给他们选择的药物。此外，医生在使用处方集药物时经常遇到不良或低于治疗效果的情况，如果他们配给首选药物，这些情况是他们不会预料到的。
