What is the Influence of the Pharmacist and Formulary in mental illness?
Pharmacies can affect how drugs are dispensed in the prescription pathway in several ways. For example, some managed care organizations restrict the use of expensive medications with a fail-first policy. Under this policy, patients can only be prescribed more expensive (and potentially more effective) medications after a less expensive medication "fails" to help.
In addition, some pharmacy benefit systems use a tiered approach to control costs. For example, in a three-tiered approach, the first tier includes the least expensive "first-line" (or "prerequisite") formulary drugs that require the lowest patient co-payment. The second tier includes brand-name formulary drugs and a higher co-payment. The third tier, involving the highest co-payment, includes brand-name non-formulary drugs.
Other ways that pharmacies can influence the prescription pathway include whether the formulary is open or closed. With an open formulary benefits plan, a drug prescribed by a physician that is not on formulary is still covered (although a high co-payment will apply). In a closed formulary plan, a drug prescribed by a physician that is not on formulary is not covered unless the physician provides medical justification.
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