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The impact of drug formularies and other approaches to improve medication use in managed care needs more study

Many managed care organizations have turned to educational outreach, formularies of "preferred" drugs, and other approaches to reduce the cost and improve the quality of medication use. A recent review of studies of these approaches and similar interventions published over a recent 6-year period indicates that some approaches, such as computerized drug alerts, show promise for improving medication use in the short term, but little is known about longer-term effects on patient care.

Researchers searched the medical literature from July 2001 to January 2007 for articles describing interventions targeting drug use conducted in managed care settings in the United States. Of 164 relevant studies, the most frequent interventions were formulary interventions (66 papers), including identifying preferred medications and linking to copayment tiers. Other interventions included educational (20 papers), including dissemination of educational materials, outreach to groups, or one-on-one outreach to individuals; monitoring and feedback (22 papers), including audits of retrospective prescribing data with feedback or computerized alerts; collaborative care involving pharmacists (15 papers); and disease management programs with drug therapy as a primary focus (41 papers), including management of depression, asthma, and peptic ulcer disease.

Interventions that the researchers found to be effective included one-to-one educational outreach (also called academic detailing), computerized alerts and reminders, pharmacist-led collaborative care, and multifaceted disease management. Dissemination of educational materials alone had little impact, and the impact of group education was inconclusive, according to Dr. Lu and colleagues. Changes in drug formulary tier design and increases in associated copayments resulted in reduced use of specific drugs, but the increased out-of-pocket spending by patients in some studies reduced utilization of essential medicines for certain chronic illnesses.

The study was funded in part by a grant from the Agency for Healthcare Research and Quality (HS10391) to the HMO Research Network Center for Education and Research on Therapeutics (CERT). For more information on the CERT program, please visit http://www.ahrq.gov

More details are in "Interventions designed to improve the quality and efficiency of medication use in managed care: A critical review of the literature-2001-2007," by Christine Y. Lu, Ph.D., Dennis Ross-Degnan, Sc.D., Stephen B. Soumerai, Sc.D., and Sallie-Anne Pearson, Ph.D., in the April 2008 BMC Health Services Research, available on the Web only at

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