title: Do the incentives in 3-tier pharmaceutical benefit plans operate as intended? Results from a physician leadership survey.
abstract: BACKGROUND
  Three-tier pharmaceutical benefit systems use graded co-payments to steer patients toward "preferred" formulary medications.
  
  
  OBJECTIVE
  To evaluate physicians' knowledge of formularies and out-of-pocket costs in such systems, as well as their perceived responsibility for helping patients manage out-of-pocket costs.
  
  
  METHODS
  Self-administered written survey.
  
  
  METHODS
  Physician leaders participating in the California Medical Association Leadership Conference were surveyed.
  
  
  RESULTS
  A total of 133 responses were received from 205 participants (65% response rate). Physicians reported that they were often unaware of patients' out-of-pocket costs at the time of prescribing. Fifty-nine percent of physicians reported that they never or seldom were aware of patients' "preferred" (lower cost) formulary options when prescribing, and 70% never or seldom were aware of patients' out-of-pocket costs when prescribing. Although 88% of physicians agreed that it is important that patients' out-of-pocket costs for prescription drugs are managed, only 25% strongly or somewhat agreed that it is their "responsibility" to help. Instead, 69% of physicians believed that it is the responsibility of the pharmacist to be familiar with patients' out-of-pocket costs. Physicians reported that they receive phone calls from pharmacists concerning formulary issues after 18.6% of the prescriptions they write.
  
  
  CONCLUSIONS
  Physician leaders reported that they often do not possess the knowledge to assist patients in managing out-of-pocket costs for prescription drugs and they depend on pharmacists to communicate patient preferences in making prescribing decisions. As a result, price preferences are communicated indirectly, likely less efficiently, rather than intentionally when prescribing decisions are made.
authors.affiliation: Division of General Internal Medicine, VA Greater Los Angeles Health Care System, Los Angeles, Calif 90073, USA. William.Shrank@med.va.gov
authors.forename: William H
authors.initials: WH
authors.lastname: Shrank
authors.forename: Henry N
authors.initials: HN
authors.lastname: Young
authors.forename: Susan L
authors.initials: SL
authors.lastname: Ettner
authors.forename: Peter
authors.initials: P
authors.lastname: Glassman
authors.forename: Steven M
authors.initials: SM
authors.lastname: Asch
authors.forename: Richard L
authors.initials: RL
authors.lastname: Kravitz
mesh_terms: D003625:Data Collection; D003669:Deductibles and Coinsurance; D005260:Female; D005382:Financing, Personal / Q000706:statistics & numerical data; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007356:Insurance, Pharmaceutical Services; D007400:Interprofessional Relations; D007857:Leadership; D008297:Male; D008875:Middle Aged; D009042:Motivation; D010595:Pharmacists; D010820:Physicians; D014481:United States