Study limitations
The findings reported here should be interpreted in light of some limitations of this study. The response rate to our mailed patient survey was modest (36%), although typical for this method. The sex mix of respondents was similar to that of nonrespondents, but nonrespondents were slightly younger. Given that younger age is associated with a greater likelihood of experiencing a problem filling a medication, our findings may underestimate the frequency of this dilemma. In addition, our survey asked patients to recall events that occurred over the past year, introducing a potential for recall bias.
While the overall sample size was relatively small (n=428), it is close to the number calculated for sufficient power to conduct the analyses (n=480). Furthermore, data were collected from 3 distinct patient populations: urban, suburban and semirural. Although the scope of our study included only one geographic region, variability in practice setting lends some tentative support to the generalizability of the findings.
Looking forward
As a standard method to control costs and update treatment guidelines, insurance-mediated medication changes will continue to present unique challenges for patients and health care providers. Formulary changes burden the downstream delivery of medical care with expensive administrative responsibilities and disrupt effective disease management and prevention. Until insurance companies and pharmacy benefit managers start paying heed to total costs of care when contemplating formulary changes, physicians should try to identify formulary conflicts as early as possible in the prescribing process so as to save time for all parties later and improve compliance.
As practices proceed toward adoption of electronic health records, e-prescribing, and the Centers for Medicare & Medicaid Services’ “meaningful use” criteria, physicians may use systems that provide real-time formulary information, which can flag issues before the patient leaves the exam room. Future research should explore the ways formulary changes might be implemented to provide the strongest continuity of patient care with the least amount of cost shifting.
CORRESPONDENCE
Susan A. Flocke, PhD, CWRU Department of Family Medicine & Community Health, 11000 Cedar Avenue, Suite 402, Cleveland, OH 44106; susan.flocke@case.edu