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Formulary changes to consider in emerging trend

Medicare & Reimbursement Advisor Weekly, October 9, 2009

In a study to be published later this year, hospitals interviewed have adjusted their formularies or discharge protocols as a result of Medicare’s readmission focus (details in Survey snapshot, left sidebar). Some of the hospitals making formulary adjustments have already moved to more open or less restrictive formularies or are considering adjustments to reduce medication changes pre-discharge for high-risk, chronically ill patients in the major categories, such as congestive heart failure and acute coronary syndrome. The emerging trend may ultimately not evolve; however, with Medicare possibly moving to a time when they don’t pay hospitals for readmissions for certain diseases (see Fig- ure 1 below of diseases most susceptible to readmission), the strategic thinking here is to make institutional changes that could reduce readmission risk. The complete findings of this study will be published later. From a managed markets perspective, think of this trend as something to follow and possibly as a benefit to typically restricted products or those that could help patients stay out of the hospital with an effective adherence program.

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