Newsletter Vol.32, no. 32

PMA NEWSLETTER

- 5 -

August 20, 1990

"PMA appeared twice before the panel and many of its recommendations
were subsequently incorporated in the committee's final report."
84% OF MDs SUPPORT LAWS BANNING THERAPEUTIC INTERCHANGE, GALLUP FINDS
More than three-quarters of American physicians would outlaw therapeutic
alternates -- routine use of only the cheapest drug within a therapeutic
class, the Gallup Organization reports. Such interchange is the keystone
of S 2605, Senator David Pryor's Medicaid drug plan.
Gallup's recent survey for the Oregon Medical Association assessed
physician attitudes towards a number of managed-care issues. Interviewers found 70% of US physicians "strongly support" legislation
prohibiting therapeutic drug interchange -- the ultimate in restricted
formularies -- another 14% "support" such laws. Five percent oppose
this legislation; 7% more "strongly oppose" it. Only 3% were unsure.
Little wonder for the strong feeling. Physicians reported grave effects
of even restricted drug formularies. Nine cited deaths; that's only 2%
of the total Gallup sample, but many MDs cited serious problems: 114
(28%) reported lessened therapeutic response; 98 reported therapeutic
failure (24%); followed by 51 reports of allergic reactions/side
effects, 50 mentions of poor/loss of blood pressure, and sizable numbers
of heart failure, convulsions, etc.
Gallup interviewed 500 randomly selected high-prescribers -- cardiologists, general practitioners, internists -- nationwide, another 200 in
Oregon, by telephone last January. Two-thirds of the national sample;
3/4 of the Oregon physicians, treated HMO, PPO and other managed care
plan patients. Virtually all treated Medicaid patients. Yet the confidential, preliminary Gallup report shows that these MDs oppose
formularies, prior authorization and especially therapeutic interchange
-- even within health plans:
THERAPEUTIC DRUG INTERCHANGE: "Very large majorities strongly
disapprove of this policy as applied in the managed care setting...Fully
87% of the physicians with HMO/PPO patients nationwide...report their
largest managed care plan does not use therapeutic drug interchange."
GENERIC SUBSTITUTION: "Data show...strong disapproval of mandatory
generic substitution policies in managed care plans (nationally, 23%
approve vs 74% disapprove)."
STEP CARE (defined as "A policy that requires doctors to prescribe drugs
in a fixed order. Usually lower-priced drugs are prescribed first and
more expensive drugs are reserved for use at a later treatment stage."):
"Very strong disapproval of step care protocols in HMOs/PPOs; only 10%
of US physicians approve of these policies...just 3% of MDs nationwide
report that the managed care plan which provides them with the most
patients uses a step care protocol approach to drug prescribing."
FORMULARIES: "Nationally, a solid majority of physicians disapprove of
formularies by a margin of 58% to 35%...20% of US physicians with
HMO/PPO patients report that their largest managed care plan uses a
formulary."

PRIOR AUTHORIZATION ("requires physicians to get approval to prescribe
certain drugs each time they feel it necessary to do so"): "Data show