NACDS expressed support for CMS' encouragement of plans to cover a patient's existing nonformulary
drugs as ff they were formulary drugs for the first 30 days of coverage after January 1.
"Drug Review Process is Standardized at the National Level, but Actions Are Needed to Ensure Timely Adjudication of Nonformulary
Drug Requests." GAO 10-776 [accessed on July 31, 2014].
and pediatricians, emergency health care, specialty care, nonformulary
drugs, and clinical trials.
If someone showed that a restriction was causing patient harm, the board certainly had to figure out how to deal with it, either by lifting the restriction or allowing a review process for people who really needed certain nonformulary
The most common arrangement is a three-tier structure with increasing copay amounts for generics, formulary brand names and nonformulary
NEBRASKA A formulary is established, but there is a process in place for making a nonformulary
request via the medical director.
I suspect that in the final analysis, the biggest problem in getting nonformulary
medications is not that the resource doesn't exist but that the people working within it don't want to deal with the paperwork or meetings that are required to justify' the request for something not routine or on the approved VANF (Veterans Affairs National Formulary).
This dynamic format includes detailed utilization reports for formulary and nonformulary
medications, formulary management, recognition of newly available generic medications, cost-containment measures, vendor prescribing practices and formulary compliance, and tracking of highest-cost medications and protocols (HIV and hepatitis C).
If a request for a nonformulary
drug is approved, health plans must make it available for the duration of the emergency situation.
Such a change would severely limit the ability of beneficiaries to get nonformulary
medications from their local pharmacy, the statement noted, adding that threatening beneficiary access "will only increase the use of most costly medical interventions, such as physician and emergency room visits."
Thus, the very large substitutions that we observed toward atorvastatin and away from simvastatin and rosuvastatin presumably resulted from the fact that providers could now prescribe atorvastatin--a more potent drug than what was previously available on formulary--with greater ease and without needing to request it through nonformulary
The process for prescribing formulary items was much faster than for nonformulary