Formulary Restrictions In Health Care

Drug prescription is an essential component of the modern health care system; however, even as billions of prescriptions are filled annually in the United States (Kaiser Family Foundation 2014), current policies governing the selection and prescription of these medications are outdated and even misguided, leading to suboptimal results in health care delivery and in public policy. With the intention of controlling rising expenses, programs such as Medicaid have implemented formulary restrictions that limit access to certain medications (Koyanagi et al. 2005). While some of these limitations have been productive, other policy decisions have had unintended consequences. Studies indicate that formulary restrictions as a whole have lowered pharmacy …show more content…
The authors of a nationwide Medicaid study assert that “although formulary restrictions hold the promise of reduced Medicaid outlays for pharmaceuticals, they may… raise Medicaid costs in other areas” (D. P. Goldman et al. 2014). In one study, researchers found that limiting patients to three prescriptions a month sharply increased the use of emergency services by mental health patients (Soumerai et al. 1994). In fact, the study estimates that mental health care costs for these patients exceeded savings by a factor of 17 (Soumerai et al. 1994). Yet another study asserts that Medicaid prior authorization policies alone increased the overall nationwide prison population by 2% (D. Goldman et al. 2014). It is estimated that restrictive Medicaid formulary policies increased incarceration costs “by $362 million nationwide” in 2008 (Seabury et al. 2014). All the aforementioned evidence demonstrates that so-called cost-reducing policies ultimately shift burdens to other sectors, often incurring greater net social …show more content…
The health care system in the United States is complex, involving many parties with diverse interests. Change is an elusive goal. Even so, policymakers must understand that there need not be an absolute tradeoff between providing the needed care to patients and minimizing expenses. Policymakers must also that understand laws passed in legislature have limits, as they do not account for the intricacies involved in providing treatment to patients with individual circumstances. Working together with health care providers, who treat patients on a more personal level, our leaders can perhaps develop a more effective formulary system that better fulfills the goals of our society in