Table 3.
Formulary Inquiries for New Pharmacologic Agents
| Rocklatan | Rhopressa | Simbrinza | Vyzulta | Combigan | |
|---|---|---|---|---|---|
| Formulary Inquiry, n | 211 | 152 | 112 | 90 | 3 |
| First pharmacy reply, n (%a): | |||||
| Covered | 125 (59%) | 132 (87%) | 100 (89%) | 69 (77%) | 1 (33%) |
| Not on formulary | 81 (38%) | 16 (11%) | 9 (8%) | 16 (18%) | 2 (67%) |
| PA needed | 8 (4%) | 5 (3%) | 4 (4%) | 5 (6%) | 0 (0%) |
| Drug added, n | 66 | 10 | 27 | 20 | 0 |
| Not Covered, n (%b) | 1 (2%) | 3 (30%) | 7 (26%) | 2 (10%) | 0 (0%) |
| $0 - $10, n (%b) | 53 (80%) | 4 (40%) | 19 (70%) | 15 (75%) | 0 (0%) |
| $11 - $50, n (%b) | 11 (17%) | 3 (30%) | 1 (4%) | 1 (5%) | 0 (0%) |
| $51 - $100, n (%b) | 1 (2%) | 0 (0%) | 0 (0%) | 2 (10%) | 0 (0%) |
| $100+, n (%b) | 0 (0%) | 0 (0%) | 0 (0%) | 0 (0%) | 0 (0%) |
| Drug added without extra steps, n (%b) | 31 (47%) | 6 (60%) | 24 (89%) | 17 (85%) | 0 (0%) |
| Drug added with extra, n (%b) | 35 (53%) | 4 (40%) | 3 (11%) | 3 (15%) | 0 (0%) |
| Prior Auth, n | 3 | 1 | 1 | 1 | 0 |
| Formulary Exception, n | 32 | 3 | 2 | 2 | 0 |
| Tier Exception, n | 0 | 0 | 0 | 0 | 0 |
| Drug not added, n | 145 | 142 | 85 | 70 | 3 |
| Not Covered, n (%c) | 41 (28%) | 12 (8%) | 1 (1%) | 22 (31%) | 1 (33%) |
| $0 - $10, n (%c) | 25 (17%) | 49 (35%) | 28 (33%) | 14 (20%) | 0 (0%) |
| $11 - $50, n (%c) | 33 (23%) | 46 (32%) | 23 (27%) | 10 (14%) | 1 (33%) |
| $51 - $100, n (%c) | 14 (10%) | 7 (5%) | 19 (22%) | 11 (16%) | 0 (0%) |
| $100+, n (%c) | 32 (22%) | 28 (20%) | 14 (16%) | 13 (19%) | 1 (33%) |
Notes: First pharmacy reply: Initial replies from institutional pharmacy to the outpatient pharmacy assistance order set (formulary inquiry) had three potential outcomes. The medication of interest could be covered by patient’s insurance, not on formulary (requiring a formulary exclusion), or require a prior authorization. Extra steps: Following the initial formulary inquiry, the patient’s insurance may have required additional steps by the physician and pharmacy to gain coverage or reduce patient out-of-pocket costs including prior authorizations, formulary exclusions, or tier exceptions. aDenominator of percentage is total formulary inquiries (“Formulary Inquiry”). bDenominator of percentage is total formulary inquiries resulting in medication of interest being added (“Drug added”). cDenominator of percentage is total formulary inquiries resulting in medication of interest not being added (“Drug not added”).