Formularies, costs, and quality of care

I read with interest the debate between Labiner and Drake vs Jones about formulary restrictions, in particular for epilepsy.1,2 While the authors have taken polarized views on the subject for the sake of fostering a lively debate, clearly the answer lies somewhere in between. At its most basic level, a formulary may be defined as a book containing a list of pharmaceutical products with their formulas and means of preparation. One of the main functions served by formularies today is to specify which medicines are approved to be prescribed for a particular ailment. I agree with Labiner and Drake that formulary restrictions often limit physician autonomy, thereby forcing us to modify our drug of choice. This is especially evident in the care of the patient with epilepsy, where physicians are compelled to prescribe generic as opposed to brand name anticonvulsants. That said, physician prescribing practices vary widely based on the level of training (resident physician in training vs one just out of residency vs an experienced physician), the practice setting (rural vs urban), and finally the availability of drugs. For the old-timers among us, sodium valproate may still be the drug of choice for patients with primary generalized epilepsy, while the young ones (young in age, not necessarily in experience!) may prefer lamotrigine. Formulary restrictions play a vital role in maintaining quality and consistency of care. To that end, I also agree with Dr. Jones that limiting formularies is not harmful to all our patients.

Disclosures

N. Sethi serves as Associate Editor for The Eastern Journal of Medicine.

Correspondence to: sethinitinmd@hotmail.com