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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.

Table of Contents

  • Errata (released February 23, 2004)

  • Summary

  • Preface

    All Prefatory Materials

  • Chapter 1

    Introduction

  • Chapter 2

    Study Background

  • Chapter 3

    Survey and Sample Design

  • Chapter 4

    Data Collection and Response Analysis

  • Chapter 5

    Summary of Findings (includes corrections)

  • Chapter 6

    Conclusions

  • Appendix A

    Survey Materials for Direct-Care Prescribers

  • Appendix B

    Survey Materials for Purchased-Care Prescribers

  • Appendix C

    Coefficients and Odds Ratios Used in the Non-Response Analysis

  • Appendix D

    Detailed Data on Survey Responses

  • Appendix E

    Comments from Survey Respondents

  • Supplemental

    Supplementary Material

The research described in this report was sponsored by the Office of the Secretary of Defense (OSD). The research described in this report was sponsored by the Department of Veterans Affairs (DVA). The research was conducted jointly by the RAND Health Center for Military Health Policy Research and the Forces and Resources Policy Center of RAND's National Defense Research Institute, a federally funded research and development center.

This report is part of the RAND Corporation Monograph report series. The monograph/report was a product of the RAND Corporation from 1993 to 2003. RAND monograph/reports presented major research findings that addressed the challenges facing the public and private sectors. They included executive summaries, technical documentation, and synthesis pieces.

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