OBJECTIVES

Formulary changes occur regularly with a goal to achieve cost savings without sacrificing quality. National health care expenditure was over $3 trillion in 2015 and millions of patients are impacted by changes such as increased copayments, co-insurance, generic brands substitution or drug therapy additions/deletions. The impact on health outcomes may be positive or negative. For most health plans, patients are made aware of benefit structure changes by mail or email, but the majority of patients do not pay attention or read updates and some do not understand without assistance. Fifty percent of patients remain without treatment for months or completely stop treatment, refusing alternatives. The objective of this study was to provide a comprehensive review of published studies regarding best practices in counseling patients upon changes to their formularies.

METHODS

Systematic review of literature (2008-2018) was conducted on PubMed and Scopus. The key words included: “formulary changes”, “patient outcome”, “formulary restricted”, “patient counseling”, “formulary decision making”, “formulary limitation”. Study characteristics included author(s), source, study design, major findings, and study quality. A step by step guidebook was developed for pharmacist and patient use.

RESULTS

A total of 52 articles were included. Formulary restrictions were shown as effective, however, literature on the humanistic aspects is lacking. Positive impact included improvements in intermediate outcomes. Negative impact included increased acute care events, side effects and symptoms. While overall healthcare costs decreased, there were increased inpatient admissions, lab testing and ambulatory procedures. The most important counseling aspects were medication adherence, treatment satisfaction, alternative therapies, and pharmacy costs. Findings differed by type of payer (commercial vs. Medicare), disease state, or drug class.

CONCLUSIONS

Proper communication is the most important step in approaching patients to discuss changes to their formularies. Utilizing a comprehensive guidebook may result in positive health outcomes in terms of treatment continuation and compliance with new costs.