How effectively do managed care organizations influence prescribing and dispensing decisions?
Carroll NV. School of Pharmacy, Virginia Commonwealth University, Richmond, VA 23298, USA. nvcarrol@vcu.edu OBJECTIVE: To examine the extent to which managed care organizations (MCOs) use formularies, therapeutic interchange, and prior approval and to determine how effectively these tools influence prescribing and dispensing decisions. RESEARCH DESIGN: Literature review. PATIENTS AND METHODS: Studies relating to effectiveness were identified through a comprehensive literature review using the MEDLINE and International Pharmaceutical Abstracts databases. Only peer-reviewed studies done in outpatient settings were included. Studies measuring extent of use were taken primarily from published and widely available marketing research reports. RESULTS: Closed formularies were found to be effective in decreasing the utilization, but not necessarily the cost, of prescription drugs. Just under half of health maintenance organizations (HMOs) and 10% of employer-sponsored health plans use closed f
