Mullins C Daniel, Palumbo Francis B, Saba Mojdeh
Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, MD 21201, USA.
Am J Manag Care. 2007 Jun;13(6 Pt 2):377-84.
To examine the relative preferred placement of commonly dispensed prescription drugs and to assess variations in drug coverage across a convenience sample of 12 health insurance plans.
A cross-sectional analysis of the plans focused on all 67 patented brand-name prescription drugs from among the top 200 prescribed drugs in 2004.
For each plan, we created a preferred placement index representing the percentages of drugs that were positioned on the formulary with preferred placement, defined as tier 2 without restricted access. A separate cardiovascular index was also created. Sensitivity analyses determined the effect of limiting the sample to the top 25 patented branded drugs and examined the robustness of our index when prior authorization restrictions were allowed.
Across 67 drugs and 12 insurance plans, drugs were rated as having preferred placement 59.1% of the time. The preferred placement index ranged from 31.3% to 88.1% across the plans for the full sample of 67 drugs; for the sample of cardiovascular drugs, the range was 25.0% to 100.0%. Results were robust across sensitivity analyses.
Based on this convenience sample of 12 formularies, there is a wide variation in preferred placement of the most commonly prescribed branded medicines across insurers. The wide range implies that the specific insurance coverage a patient selects may have an effect on whether his or her prescribed drugs have preferred formulary placement and on his or her out-of-pocket drug expenditures.
研究常用处方药的相对优先放置情况，并评估12种医疗保险计划便利样本中药物覆盖范围的差异。
对这些计划进行横断面分析，重点关注2004年处方量排名前200的所有67种专利品牌处方药。
对于每个计划，我们创建了一个优先放置指数，该指数代表放置在处方集上具有优先放置资格的药物百分比，优先放置定义为无限制使用的二级。还创建了一个单独的心血管指数。敏感性分析确定了将样本限制在前25种专利品牌药物的影响，并在允许事先授权限制的情况下检查了我们指数的稳健性。
在67种药物和12种保险计划中，药物被评为具有优先放置资格的时间占59.1%。在67种药物的完整样本中，各计划的优先放置指数范围为31.3%至88.1%；对于心血管药物样本，范围为25.0%至100.0%。敏感性分析的结果很稳健。
基于这12种处方集的便利样本，各保险公司最常用的品牌药物的优先放置情况存在很大差异。这种广泛的差异意味着患者选择的特定保险覆盖范围可能会影响其处方药是否具有优先处方集放置资格以及其自付药物费用。
