As insurers redouble their efforts to contain drug costs, physicians must navigate a thicket of different formularies, complex co-payment structures with three or four tiers and rising pressure to switch to generic drugs.
One useful tool for many doctors is the handheld computer loaded with drug-review software that allows doctors to instantly slice and dice drug information that would be time-consuming to look up in a drug reference book.
With his handheld, Alan King, D.O., a Sarasota, Fla. internist-pediatrician, says he can help patients control their drug costs and still save time. While patients are still in the examining room, King taps his handheld a few times and tells them a drug's typical price, its generic equivalent, whether or not it's on the formulary of their insurance plan, and even what pill count would be least costly.
"It's a service for patients, and it shows them I am sensitive to the cost," he says. Since he does not have to leaf through paper formularies and other references, "I'm doing it in a very minimal amount of time," he adds.
King uses software from San Carlos, Calif.-based ePocrates, but other companies, such as Allscripts Healthcare Solutions of Libertyville, Ill., have similar products.
A basic feature of these systems is the ease with which doctors can find a generic equivalent. Pharmacists say there are some 800 to 1,000 generic drugs, almost all of which can be safely substituted for brand-name drugs, but it's hard to remember their names, and looking them up in a drug reference book is
The savings from generics are substantial. Pharmacists say generics typically cost 30% to 80% less than their brand name counterparts.
Some doctors insist generic drugs are different and can cause discomfort when patients switch to them, but that is a "myth," says Glenn Perry, director of pharmacy services administration at Blue Cross Blue Shield of Michigan. So far, 40 to 50 U.S. insurers, including the Michigan Blues, have agreed to provide their formularies to ePocrates.
"Doctors can't carry around 10 different formularies in their pocket," Perry says.
King says the formularies are regularly updated and tend to be more current than the paper formularies sent by insurers. But he reports that Blue Cross Blue Shield of Florida has not yet agreed to supply its formulary to ePocrates, while smaller plans in his area have done so.
"I was skeptical of handhelds for a long time," says Michael Burry, D.O., family physician in Livonia Mich., who also uses ePocrates software. "I am by no means a computer whiz, but the system is very easy to follow."
In addition to cost information, Burry says a new ePocrates feature available this year allows him to cross-check up to 30 drugs to see if there are any harmful interactions. So far, he says, he has checked as many as 15 drugs for interactions for one patient.