Do the incentives in 3-tier pharmaceutical benefit plans operate as intended? Results from a physician leadership survey.
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.
Shrank
William H
WH
Division of General Internal Medicine, VA Greater Los Angeles Health Care System, Los Angeles, Calif 90073, USA. William.Shrank@med.va.gov
Young
Henry N
HN
Ettner
Susan L
SL
Glassman
Peter
P
Asch
Steven M
SM
Kravitz
Richard L
RL
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