TABLE 4.
Formulary Restrictions on the 300 Most Common Prescription Drugs for the Elderly, by Plan
| Type of Formulary Restriction |
||||
|---|---|---|---|---|
| Plan | Prior Authorization |
Quantity Limits |
Step Therapy | Other |
| Part D Plans | ||||
| A | 0 | 90 | 5 | 0 |
| B | 0 | 90 | 5 | 0 |
| C | 0 | 90 | 5 | 0 |
| D | 0 | 55 | 12 | 0 |
| E | 2 | 59 | 12 | 0 |
| F | 2 | 53 | 14 | 0 |
| G | 1 | 14 | 0 | 0 |
| H | 0 | 0 | 0 | 0 |
| I | 3 | 34 | 0 | 0 |
| J | 7 | 7 | 7 | 0 |
| Non-Part D Plans | ||||
| Medi-Cal | 70 | 6 | 4 | 6 |
| TRICARE | 4 | 12 | 0 | 4 |
| CALPERS | 0 | 0 | 0 | 0 |
| Blue Cross | 4 | 8 | 0 | 0 |
| FEP | 35 | 8 | 0 | 3 |
| VA | 0 | 0 | 0 | 36 |
| Kaiser | 0 | 0 | 0 | 0 |
Sources: Fingertip Formulary, 2007.
Prior authorization requires permission from the plan before certain drugs can be dispensed; Step therapy requires use of lower-cost medications before providing coverage for more expensive alternatives; Quantity limits restrict the number of pills or prescriptions dispensed per month or per patient. Other restrictions typically include coverage only for a specific indication or dosage/form.