title: The effect of insurance-driven medication changes on patient care.
abstract: OBJECTIVE
  Insurance plans periodically change their formularies to enhance medical efficacy and cost savings. Patients face challenges when formulary changes affect their treatment. This study assessed the impact of insurance-driven medication changes on primary care patients and examined implications for patient care.
  
  
  METHODS
  We mailed questionnaires to a cross-sectional random sample of 1200 adult patients who had visited one of 3 family medicine practices within the past 6 months, asking them to describe problems they had encountered in filling medication prescriptions. We performed descriptive analyses of the frequency and distribution of demographic variables and conditions being treated. Using logistic regression analysis, we identified demographic and health-related variables independently associated with patient-reported problems caused by formulary changes.
  
  
  RESULTS
  Three variables-a greater number of prescription medications taken, younger patient age, and reliance on government insurance-were independently associated with an increased likelihood of encountering a problem filling a medication. Patients who reported an insurance-related issue filling a new or existing prescription over the past year (23%) encountered an average of 3 distinct problems. Patients experienced adverse medical outcomes (41%), decreased satisfaction with the health care system (68%), and problems that burdened the physician practice (83%). Formulary changes involving cardiac/hypertension/lipid and neurologic/psychiatric medications caused the most problems.
  
  
  CONCLUSIONS
  Insurance-driven medication changes adversely affect patient care and access to treatment, particularly for patients with government insurance. A better understanding of the negative impact of formulary changes on patient care and indirect health care expenditures should inform formulary change practices in order to minimize cost-shifting and maximize continuity of care.
authors: Department of Family Medicine, Case Western Reserve University, South Russell Family Practice, Cleveland, OH, USA.
authors: Mark N
authors: MN
authors: Rood
authors: Wanda
authors: W
authors: Cruz-Knight
authors: James
authors: J
authors: Cunagin
authors: Stephen J
authors: SJ
authors: Zyzanski
authors: James J
authors: JJ
authors: Werner
authors: Mary Jane
authors: MJ
authors: Mason
authors: Peter J
authors: PJ
authors: Lawson
authors: Kurt C
authors: KC
authors: Stange
authors: Susan A
authors: SA
authors: Flocke
mesh_terms: D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D057915:Drug Substitution / Q000009:adverse effects / Q000191:economics / Q000706:statistics & numerical data*; D005194:Family Practice; D005260:Female; D019538:Health Care Surveys; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D007356:Insurance, Pharmaceutical Services; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009820:Ohio; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D055553:Prescription Drugs / Q000191:economics; D011795:Surveys and Questionnaires
chemical_list: D055553:Prescription Drugs