As drug costs mount, managed-care organizations are relying more on formularies, or preferred lists of medicines, to help rein in bills.
Formularies steer doctors and patients toward generics first and brand-name drugs second. Usually included are drugs for which insurers have negotiated discounts and rebates (See cover story, p. 30).
Doctors are exasperated by the increased use of formularies, because every HMO has its own menu, and no two are alike.
"The development of specific managed-care formularies has created a new wrinkle and difficulty in taking care of people," said Gary Sobelson, M.D., a family physician in Concord, N.H.
In New Hampshire, the Foundation for Healthy Communities, a not-for-profit organization funded by hospitals and insurers in the state, applied a little Yankee ingenuity to the problem. It developed a pocket reference card that lists generic drugs in the most commonly prescribed categories and brand-name drugs on the formularies of each of the four main HMOs in the state. The brand-name drugs are in ascending order by cost.
The card allows doctors to more easily select the right drug for patients when they write their prescriptions.
In February, the foundation mailed three of the pocket guides to every physician in the state. A second edition and a wall chart are slated for distribution in September. Sobelson said he welcomed the formulary cheat sheet as much for its symbolic value as for its content.
"The best thing about it . . . is that (the managed-care companies) actually got together and did something."
Speaking for the six doctors in his practice, Sobelson said, "We all want to be rational prescribers; we want to prescribe the right drug, and we want to save money."
Up-to-date information on formularies, which change often, is critical, he said, and the card is a good start.
Ultimately, though, Sobelson is counting on computer-based prescribing systems that would give immediate feedback on any drug choice.
For now, the hard copy will probably be the way for most doctors to go.
The insurers that helped develop the card plan to stay the course.
"We committed to redoing this every six months so that it will be current," said Allen Hinkle, M.D., medical director for Blue Cross and Blue Shield of New Hampshire.
Hinkle said it's too early to tell how much the cards have influenced prescribing habits and clinical outcomes. But doctors have expressed their satisfaction with the card, he said. In fact, hospital and retail pharmacists have heard about the card and want to get it, Hinkle said. That possibility is being discussed and will probably happen later this year, he added. Eventually, enrollees may also get a version of the card.