FORMULARY LIMITATIONS AND THE ELDERLY - RESULTS FROM THE MANAGED CAREOUTCOMES PROJECT

Objective: To examine whether restrictive formularies are associated w ith differences in healthcare resource utilization, including number o f office visits, prescriptions, and hospitalizations, and whether this association varies by age. Study Design: Cross-sectional, longitudina l study. Patients and Methods: Patients enrolled in one of six health maintenance organizations in six different states, three in the easter n and three in the western United States, were eligible for the study. Data from between 1309 and 3938 patients were available for analysis for each of the five diseases studied, for a total of 12,997 patients across all study diseases. Healthcare utilization by patients in the s tudy included more than 99,000 office visits, 1000 hospitalizations, a nd 240,000 prescriptions. We used severity-adjusted prescription count s, prescription costs, office visit counts, and measures of inpatient hospital utilization to assess the effects of formulary limitations. R esults: We found positive, significant associations between the indepe ndent variable formulary limitations in drug class and the dependent v ariables measuring resource utilization. These associations were somet imes significantly greater for elderly patients after controlling for severity of illness and other variables. Conclusions: Common strategie s for decreasing drug expenditures may be associated with higher sever ity-adjusted resource utilization. In specific areas, this association is more pronounced in the elderly.