--- Erik Reuter <[EMAIL PROTECTED]> wrote: > Deborah Harrell wrote: > > > http://my.webmd.com/content/Article/49/39665.htm?printing=true <snip> > "The survey, commissioned by Project Patient Care > and conducted by > Harris Interactive, suggests that drug plan > formularies may have a > negative impact on the health of Americans who rely > on prescription drugs." > > The article doesn't give anywhere near enough > details to establish the > credibility or accuracy of this "survey". Do you > have any evidence to > support the quality of information from "Harris > Interactive" surveys?
No. I have my and multiple colleagues' general impressions regarding said policies. If you will recall, I said that I do not have objections to *guidelines,* which are usually based on efficacy, side effect profiles, cost, and - in the case of antibiotics - local bacterial resistances. Many generics are just as good as the brand names - but not all (it isn't that the *drug* is different, but the _bioavailbility_/delivery system may be quite different. This is true of OTC drugs as well, BTW - frex some super cheap vitamin formulations do not dissolve in the typical stomach or small bowel transit time, so the taker essentially gets no benefit.) Doing a Medline search for [drug AND (switch OR change) AND formulary] yields these, among others (unfortunately, abstracts do not state who funded the study, although some clearly are by an HMO group or the Veterans Administration): http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11478507&dopt=Abstract "In conclusion, the formulary change had a negative impact upon health outcomes among failure patients but did not significantly affect their health care utilization costs. Identification of failure patients early in their lansoprazole trial periods could have improved their health outcomes and satisfaction with medical care." (2001 VA study) http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10537869&dopt=Abstract "Omeprazole was the medication preferred by patients for GERD maintenance therapy. Patients were willing to pay an additional fee for their preferred agent. Fewer adverse events were reported with omeprazole. The potential cost savings of the formulary conversion may have been at the expense of patient satisfaction." (1999 VA study) http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11735668&dopt=Abstract "We conclude that the practice of having a single SSRI on the formulary for a healthcare plan seems ill founded. Patients who switch antidepressants remain in treatment 50% longer and cost approximately 50% more to treat in a more costly treatment setting. Giving the primary care physician several antidepressant choices can provide more options to continue treatment of his or her patient in the less expensive primary care setting. In terms of cost containment, formulary restrictions are far more likely to have the opposite effect." (2001 study) http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11944611&dopt=Abstract "There were no significant differences in the number of patients that had adverse effects or in the number of cycles resulting in an adverse event between groups. Sargramostim demonstrated a 21% cost savings over filgrastim ($1036 versus $1318, respectively). The formulary switch from filgrastim to sargramostim resulted in a significant cost savings for the institution without increasing incidence of adverse effects and negative outcomes associated with growth factor use." (2002 study) http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11184669&dopt=Abstract "A formulary switch from nizatidine to cimetidine can be accomplished at significant pharmaceutical cost savings, and this retrospective study suggests that this can be done without increasing other aspects of healthcare resource utilization." (2000 VA study) [I frankly find this hard to believe - my experience with 1st generation H2 blocker vs. 2nd or 3rd gen says otherwise.] http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11978149&dopt=Abstract "Substitution of Barr warfarin for Coumadin did not significantly affect INR control, warfarin management, or adverse events. Our findings suggest that HMOs can safely substitute at least 1 generic formulation of warfarin without extra monitoring." (2002 study) Strategies like three-tier prescription co-pays can either reduce prescription costs to the carrier/HMO/PPO, or shift the burden of cost to the patient - excuse me, I meant consumer ;). The 2001 recall of Baycol, a statin, reflects one problem with the charge to cheap: in this case, the drug was associated with a higher incidence of rhabdomyalysis than other statins on the market (although all have this risk to some degree). I didn't cite any of the articles that extolled the cost-effectiveness of Baycol. http://www.fda.gov/bbs/topics/ANSWERS/2001/ANS01095.html All drugs in one class or category *are not* interchangable. Two more points, and I'll shut up (...suuure): Personal responsibility/lifestyle choices factors into drug and health-care costs. Frex, smokers generally have more bronchitis and upper respiratory infections (nose/sinus/throat) than non-smokers, and chronic smokers tend to have tougher bugs, which need tougher (frequently translates to newer and more expensive) antibiotics. Those exposed to second-hand smoke may develop URIs which they would not have gotten if not exposed (<raises hand and waves> hence my complete avoidance of bars and similar venues). Drug companies advertising the newest (and of course more expensive) drugs trick the gullible into insisting on that pill - which the harried clinician may just write out, instead of taking the extra 5-10 minutes needed to explain _why_ this purple pill is not any better than the old one. [I won't rant about time constraints and resulting ill health effects - at least, not now. >:P ] Debbi __________________________________________________ Do you Yahoo!? Yahoo! Mail Plus - Powerful. Affordable. Sign up now. http://mailplus.yahoo.com _______________________________________________ http://www.mccmedia.com/mailman/listinfo/brin-l
