Khan Shamima, Sylvester Robert, Scott David, Pitts Bruce
Department of Pharmacy Practice, College of Pharmacy, Nursing, and Allied Sciences, North Dakota State University, Fargo, North Dakota, USA.
J Manag Care Pharm. 2008 Oct;14(8):780-9. doi: 10.18553/jmcp.2008.14.8.780.
Multi-tier copayment designs in pharmacy benefit plans are intended to steer patients and prescribers to preferred drug therapies that have lower out-of-pocket costs for patients.
To describe and assess physicians' prescribing experiences and opinions in a multi-tier, primarily 3-tier formulary environment in 2 Midwestern states.
This was a cross-sectional survey of physicians practicing in either Minnesota or North Dakota. A packet consisting of a survey instrument, a cover letter, and a postage-paid return envelope was mailed to a random sample of 690 physician members of the Minnesota Medical Association (n = 460, 5.1% of members) or the North Dakota Medical Association (n = 230, 25.6% of members). Surveys were mailed between March and May 2006. Nonresponders were mailed up to 2 additional surveys. Survey items included practice specialty, sources used to obtain drug information, perceived importance of cost containment actions (e.g., prescribing drug with lowest total cost, prescribing drug that minimizes patient out-of-pocket cost), and how often the physician was personally aware of the following when writing a prescription: identity of the patient's insurer, patient's pharmacy benefit structure, preferred medications on the insurer's formulary, patient's copayment (out-of-pocket cost) responsibility, and list price of the medication.
The survey response rate was 49.8% (296 of 594). The results were as follows: 93.5% of respondents agreed that it was important to prescribe the drug that would minimize the patient's out-of-pocket costs, 73.2% agreed that it was important to discuss out-of-pocket medication costs with patients, 81.8% of respondents agreed that it was important to prescribe the drug with the lowest total costs, and 33.3% of respondents believed that it was their responsibility to prescribe a preferred (formulary) medication. According to the survey, 61.6% of respondents were rarely or never aware of their patient's copayment amounts, and 42.4% were rarely or never aware of the list price of the medication. Physician specialty was associated with the awareness of the identity of the patient's insurer (generalists, 41.1% vs. specialists, 19.2%; P = 0.001) and use of personal digital assistant (PDA) when prescribing (generalists, 38.9% vs. specialists, 21.1%; P = 0.005).
Physicians who responded to this survey believed that it was important to prescribe drugs that would minimize patients' prescription copayments, but they were often unaware of the preferred medications on the formulary, the patients' copayment amounts, or the price of the drugs prescribed.
药房福利计划中的多层共付设计旨在引导患者和开处方者选择对患者自付费用较低的首选药物治疗方案。
描述和评估中西部两个州在主要为三层药品目录环境下医生的处方开具经验和意见。
这是一项对在明尼苏达州或北达科他州执业的医生进行的横断面调查。一个包含调查问卷、一封附信和一个邮资已付的回邮信封的包裹被邮寄给明尼苏达医学协会690名医生会员（n = 460，占会员的5.1%）或北达科他医学协会（n = 230，占会员的25.6%）的随机样本。调查于2006年3月至5月期间邮寄。未回复者最多再收到2份调查问卷。调查项目包括执业专科、获取药物信息的来源、对成本控制措施的感知重要性（例如，开具总成本最低的药物、开具使患者自付费用最小化的药物），以及医生在开处方时个人对以下情况的知晓频率：患者保险公司的身份、患者的药房福利结构、保险公司药品目录上的首选药物、患者的共付（自付费用）责任以及药物的标价。
调查回复率为49.8%（594份中的296份）。结果如下：93.5%的受访者同意开具能使患者自付费用最小化的药物很重要，73.2%的受访者同意与患者讨论药物自付费用很重要，81.8%的受访者同意开具总成本最低的药物很重要，33.3%的受访者认为开具首选（药品目录中的）药物是他们的责任。根据调查，61.6%的受访者很少或从未知晓患者的共付金额，42.4%的受访者很少或从未知晓药物的标价。医生专科与对患者保险公司身份的知晓情况（全科医生为41.1%，专科医生为19.2%；P = 0.001）以及开处方时使用个人数字助理（PDA）的情况（全科医生为38.9%，专科医生为21.1%；P = 0.005）相关。
参与此次调查的医生认为开具能使患者处方共付费用最小化的药物很重要，但他们往往不知道药品目录上的首选药物、患者的共付金额或所开药物的价格。
