Impact of a Uniform Formulary on Military Health System Prescribers: Baseline Survey Results

Pharmaceuticals represent one of the fastest growing components of both U.S. civilian and Department of Defense (DoD) health care expenditures. Both the DoD and U.S. Congress have identified the Military Health System pharmacy benefit as an area for reform. To this end, federal legislation requires the DoD to establish a single uniform formulary (UF) of covered drugs governing beneficiaries' access to pharmaceuticals. The legislation also requires a baseline survey conducted prior to UF implementation and a follow-up post-implementation survey. The baseline survey that is the subject of this study gauged prescribers' experiences with and perceptions of drug formularies. The study assessed their opinions about the impact of formularies on clinical decisions, aggregate cost, and quality and accessibility of health care. Two groups of TRICARE prescribers were sampled-direct-care providers within military treatment facilities and providers at network (purchased-care) facilities. Differences were observed within each sample. For example, most direct-care prescribers reported a high degree familiarity with their respective formularies and formulary management practices and perceived formulary management as contributing toward quality of care, whereas most purchased-care respondents reported less familiarity with formulary lists and the rules governing their use and did not believe that formulary management contributes to quality of care.