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AJMC review: Formulary exclusions tend toward neutral, positive patient impacts


PLAINSBORO, N.J. — A new review of several studies on the impact of drug exclusion from pharmacy benefits managers’s formularies has found that in most cases, these efforts to control costs work without negatively affecting patients. 


The review, published in the American Journal of Managed Care, looked at 26 studies of 27 formulary exclusions, 20 of which looked at the impact that exclusions had on patients. The 20 studies looked at 21 exclusions, six of which showed positive effects on patients (meaning the patients’s condition improved as a result), six of which had a negative effect (meaning more frequent or severe symptoms or lapses in disease control) and 9 of which had a neutral impact.


Some policies that had negative impacts left to increased A1C levels in diabetic patients and some that involved drugs treating psychotic disorders led to increased likelihood of acute events. Overall, though, the majority of the exclusions had a neutral or positive impact. 


“Removing drugs from formularies for which equally effective, but less expensive, alternatives are available is an attractive options,” the review says. “Our study suggests that, for the most part, these policies have been successful in reducing costs while minimizing the impact on patient care, although the exceptions provide room for caution. Decision makers should thus be mindful of the potential negative clinical and economic consequences of drug exclusion policies.”


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