Formulary Access to Insulins in Type 2 Diabetes

Mark Warren, MD: Formulary access is very important when we choose an insulin product or any product for that matter. So, when I choose a product, I want to have the best product. I choose it, I teach the patient about it, they go to get it filled. Yet, it’s not on their formulary, and then that work falls back on my staff to get the preapproval process going or, if it’s rejected, to choose another product. That requires more training of the patient, perhaps a different device, and explaining to them differences in the insulin and why we have to change. So, formulary access is a big issue for our office because it does take a lot of my staff time and a preauthorization process. That does play a role when we’re deciding on insulin. If one is equally as good and a formulary has it, then I’ll choose the one that the formulary has—if I know the formulary. But generally, I don’t really know the formulary. Our EMR doesn’t necessarily tell me the formulary, or its own formulary, and if it does, it’s usually wrong. So, I will generally prescribe the insulin that I think is the best for them. But formulary access is a big problem for us, and that does present a barrier in our ability to take care of our patients and a lot of frustration from our staff and our patients’ standpoint that they can’t get the insulin the doctor prescribed, the insulin that the physician thought was best for them. So, it’s a big barrier and a big problem for us.