A Bitter Pill: Formulary Variability and the Challenge to Prescribing Physicians

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Figure 1.
Preferred formulary placement of branded drugs in large California health plans.

Table 1.

Top 5 Expenditures in California, by Drug Class, in 1999

Drug Class	Expenditures in California
Proton-pump inhibitors and H2 antagonists	$564,670,000
Selective serotonin-reuptake inhibitors	$541,234,000
Statins	$501,528,000
CCBs	$326,658,000
ACE inhibitors	$271,670,000

Table 2.

Preferred Formulary Placement of Proton Pump Inhibitors

Proton-Pump Inhibitor	Blue Shield	Aetna	HealthNet	Pacificare	Blue Cross	Cigna	Total Formularies Offering Drug in
Proton-Pump Inhibitor	Blue Shield	Aetna	HealthNet	Pacificare	Blue Cross	Cigna	2000	2002
Aciphex (rabeprazole)	00/02^*	00/02	00/02	00/02	NP	02	4/6	5/6
Nexium (esomeprazole)	NP	NP	NP	NP	NP	NP	0/6	0/6
Prevacid (lansoprazole)	NP	00/02	NP	NP	00/02	00/02	3/6	3/6
Prilosec (omeprazole)	NP	NP	00	NP	NP	NP	1/6	0/6
Protonix (pantoprazole)	00/02	NP	00/02	00/02	02	02	3/6	5/6
Number of preferred drugs
Added by plan	0	0	0	0	1	2
Removed by plan	0	0	1	0	0	0

* 00, preferred in 2000; 02, preferred in 2002; NP, nonpreferred in 2000 or 2002.

Table 3.

Preferred Formulary Placement of Statins

Statins	Blue Shield	Aetna	HealthNet	Pacificare	Blue Cross	Cigna	Total Formularies Offering Drug in
Statins	Blue Shield	Aetna	HealthNet	Pacificare	Blue Cross	Cigna	2000	2002
Lescol (fluvastatin)	00/02^*	00/02	00/02	NP	00	02	4/6	5/6
Lipitor (atorvastatin)	00/02	NP	00/02	NP	00/02	NP	3/6	3/6
Pravachol (pravastatin)	02	NP	00/02	00/02	00/02	NP	3/6	4/6
Zocor (simvastatin)	NP	00/02	NP	02	NP	00/02	2/6	3/6
Number of preferred drugs
Added by plan	1	0	0	1	0	1
Removed by plan	0	0	0	0	1	0

* 00, preferred in 2000; 02, preferred in 2002; NP, nonpreferred in 2000 and 2002.
Baycol is not presented here because it was removed from the market for safety reasons.

Table 4.

Preferred Formulary Placement of Calcium Channel Blockers

CCBs	Blue Shield	Aetna	HealthNet	Pacificare	Blue Cross	Cigna	Total Formularies Offering Drug in
CCBs	Blue Shield	Aetna	HealthNet	Pacificare	Blue Cross	Cigna	2000	2002
Cardene (nicardipine)	NP^*	02	NP	00/02	NP	00	2/6	2/6
Dynacirc (isradipine)	NP	NP	NP	00/02	00/02	00/02	3/6	3/6
Norvasc (amlodipine)	NP	00/02	00/02	00/02	00/02	NP	4/6	4/6
Plendil (felodipine)	00/02	00	00/02	00/02	00/02	00/02	6/6	5/6
Sular (nisoldipine)	00/02	NP	00/02	00/02	00/02	NP	4/6	4/6
Number of preferred drugs
Added by plan	0	1	0	0	0	0
Removed by plan	0	1	0	0	0	1

* 00, preferred in 2000; 02, preferred in 2002; NP, nonpreferred in 2000 or 2002.

Table 5.

Preferred Formulary Placement of ACE Inhibitors

ACE Inhibitors	Blue Shield	Aetna	HealthNet	Pacificare	Blue Cross	Cigna	Total Formularies Offering Drug in
ACE Inhibitors	Blue Shield	Aetna	HealthNet	Pacificare	Blue Cross	Cigna	2000	2002
Accupril (quinapril)	NP^*	00/02	00/02	02	00/02	00/02	4/6	5/6
Altace (ramipril)	NP	02	02	02	02	02	0/6	5/6
Lotensin (benazepril)	00/02	NP	00/02	00/02	00/02	00/02	5/6	5/6
Mavik (trandolapril)	NP	02	NP	02	00/02	00/02	2/6	4/6
Monopril (fosinopril)	00/02	NP	00/02	00/02	NP	00/02	4/6	4/6
Univasc (moexipril)	NP	NP	02	00/02	NP	02	1/6	3/6
Number of preferred drugs
Added by plan	0	2	2	3	1	2
Removed by plan	0	0	0	0	0	0