Paper: High-risk medications on pharmacy discount program formularies; a brief report (2012 ACCP Annual Meeting)

Monday, October 22, 2012

Westin Diplomat Resort

Abir O. Kanaan, PharmD¹, Jennifer L. Donovan, PharmD², Darren M. Triller, PharmD³, Shawn Gagne, BS⁴ and Jennifer Tjia, MD, MSCE⁵
1Massachusetts College of Pharmacy and Health Sciences, Worcester, MA
2MCPHS University, Worcester, MA
3IPRO, Albany, NY
4Meyers Primary Care Institute, University of Massachusetts Medical School, Worcester, MA
5Meyers Primary Care Institute, a joint endeavor of the University of Massachusetts Medical School, Reliant Medical Group, and Fallon Community Health Plan, Worcester, MA

Purpose: The Medicare Modernization Act provided prescription drug coverage to Medicare and Medicaid beneficiaries to improve Medicare and address drug costs faced by the elderly. Simultaneously, large chain pharmacies offered discounted generic drug programs to attract consumers. The purpose of this study was to determine the prevalence of high-risk medications on pharmacy discount formularies compared to insurer formularies.

Methods: In this descriptive study, the formulary lists of the top five leading pharmacy operators in 2007 (CVS, Kroger, Rite Aid, Walgreens, and Wal-Mart) and a comparator group of tier-one prescription drug formularies of four health insurers in the United States (Community CCRx, Humana, UnitedHealthcare, and WellCare) were surveyed for the presence of two types of high-risk medications: drugs with black box warnings (BBW) or drugs on the Beers list. To identify and enumerate these drugs, an analyst programmed Microsoft Excel to match pharmacy and insurer formularies to Beers and BBW medications based on the active pharmaceutical ingredient. The number of matches was enumerated as the percentage of formulary drugs that overlapped with the Beers and BBW lists.

Results: Pharmacy formularies had an average of 158.4 medications (range 143-175) and tier-one insurance formularies had an average of 358 medications (range 112-476). The average number of Beers list drugs present on pharmacy formularies was 26.2 (16.5%) [range 25-30 (17.5-18.6%)] and on tier-one insurance formularies was 42 (11.7%) [range 17-54 (9.9-15.2%)]. The average number of BBW drugs present on pharmacy formularies was 58.8 (37.1%) [range 55-63 (34.5-39.1%)] and on tier-one insurance formularies was 114 (31.8%) [range 52-140 (27.7-46.4%)]. Common to both pharmacy and insurer formularies were 9 Beers list medications and 27 BBW medications.

Conclusion: The presence of high-risk medications is common and not unique to generic pharmacy discount programs, making the potential for prescribing these drugs similar amongst both pharmacy and insurer formularies.

142 High-risk medications on pharmacy discount program formularies; a brief report