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The American Journal of Managed Care Special Issue: Pharmacy Benefits
A Gray Area for Reimbursement: Medical Foods for Non–Inborn Errors of Metabolism
Leslie Wilson, PhD; Tracy Kuo Lin, MSc, PhD; Anna Oh, RN, MPH; and Vicky Cao, PharmD
Disease-Modifying Antirheumatic Drug Initiation Among Patients Newly Diagnosed With Rheumatoid Arthritis
Machaon Bonafede, PhD, MPH; Barbara H. Johnson, MBA; Neel Shah, PhD, BPharm; David J. Harrison, PhD; Derek Tang, PhD, BSPharm; and Bradley S. Stolshek, PharmD
Cost Per Response Analysis of Strategies for Chronic Immune Thrombocytopenia
Kelly Fust, MS; Anju Parthan, PhD; Xiaoyan Li, PhD; Anjali Sharma, MD; Xinke Zhang, MS; Marco Campioni, PhD; Junji Lin, PhD, MS; Xuena Wang, PhD; Richard Zur, PhD; Karynsa Cetin, MPH; Melissa Eisen, MD; and David Chandler, PhD
Costs Associated With Long-Acting Insulin Analogues in Patients With Diabetes
Berhanu Alemayehu, DrPH, MS; Jessica Speiser, MPH; Lisa Bloudek, PharmD, MS; and Evelyn Sarnes, PharmD, MPH
5-ASA to Sulfasalazine Drug Switch Program in Patients With Ulcerative Colitis
Jason R. Goldsmith, MD, PhD; Akbar K. Waljee, MD; Tom George, PharmD; Alexandra Brown, BS; Hae Mi Choe, PharmD; Mohamed Noureldin, MBBS; Steven J. Bernstein, MD, MPH; and Peter D.R. Higgins, MD, PhD
Direct Oral Anticoagulant Prescription Trends, Switching Patterns, and Adherence in Texas Medicaid
Shui Ling Wong, MS; Landon Z. Marshall, PharmD; and Kenneth A. Lawson, PhD
Two-Year Adherence and Costs for Biologic Therapy for Rheumatoid Arthritis
Bradley S. Stolshek, PharmD; Sally Wade, MPH; Alex Mutebi, PhD, MSc; Ajita P. De, MA, MPhil, MS; Rolin L. Wade, MS; and Jason Yeaw, MPH
Cost of Biologic Treatment Persistence or Switching in Rheumatoid Arthritis
Tao Gu, PhD; Alex Mutebi, PhD; Bradley S. Stolshek, PharmD; and Hiangkiat Tan, MS, BSPharm
Impact of Medical and/or Pharmacy Reimbursement on Adult Vaccination Rates
Gaurav Deshpande, PhD, MS; Jay Visaria, PhD, MPH; Joseph Singer, MD; and Kelly D. Johnson, PhD, MPH
Treatment Patterns Among Adults With ADHD Receiving Long-Acting Therapy
Zhou Zhou, MS; Zheng-Yi Zhou, PhD; Sneha S. Kellar, MPH; Vanja Sikirica, PharmD, MPH; Jipan Xie, MD, PhD; and Regina Grebla, PhD
Currently Reading
Modeling the Impacts of Restrictive Formularies on Patients With HIV
James Baumgardner, PhD; Caroline Huber, MPH; Mina Kabiri, PhD; Lara Yoon, MPH; Jacki Chou, MPP, MPL; and John Romley, PhD

Modeling the Impacts of Restrictive Formularies on Patients With HIV

James Baumgardner, PhD; Caroline Huber, MPH; Mina Kabiri, PhD; Lara Yoon, MPH; Jacki Chou, MPP, MPL; and John Romley, PhD
Constraining access to HIV regimens can have significant implications for patients. This study examined the economic and health impacts of restrictive HIV formulary designs.
ABSTRACT

Objectives: 
To model the impacts of restrictive formulary designs on outcomes for patients with HIV and to demonstrate the costs of restricting access to novel HIV regimens with better safety and efficacy profiles. 

Study Design: We modified an epidemiological model of HIV incidence, progression, and treatment to simulate the effects of 5 formulary scenarios on patient outcomes in the United States. 

Methods: Using a cohort of HIV-susceptible individuals, we followed patients through HIV infection, disease progression, and death. Patients transitioned in and out of treatment states once infected. Treatment discontinuation, efficacy, and the rate of adverse events (AEs; renal failure and bone fracture) in each formulary scenario depended on the treatment path and regimens included. Outcomes of interest included all-cause cumulative deaths, annual rates of AEs, and costs associated with treating those AEs. 

Results: All outcomes of interest were more favorable in less restrictive formulary scenarios that provided fewer barriers to appropriate treatments. By 2025, more restrictive formularies would have resulted in 171,500 more cumulative bone and renal events among treated patients with HIV compared with an open formulary. This corresponds to AE treatment costs of $3.65 billion in more restrictive formularies compared with $1.43 billion in an open formulary. Finally, compared with an open formulary, there would be an additional 16,200 cumulative deaths in more restrictive formularies. 

Conclusions: Less restrictive formulary designs, which allow patients with HIV to initiate potentially safer and more efficacious regimens based on their proclivity to AEs, yield better outcomes and reduce costs. 

Am J Manag Care. 2018;24(Spec Issue No. 8):SP322-SP328

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