editor's perspective

Keep This List on Your Watch List

By Jason J. Nichols, OD, MPH, PhD, FAAO

Have you ever thought much about “lists” and how much they impact our daily lives? Many of us live by lists—“to do” lists, mailing lists, grocery lists, black lists, bucket lists, favorites lists, and playlists to name a few. Lists serve many good functions in our lives and help us stay on the straight and narrow path. In fact, lists often serve as the primary organization tool used by most of us personally, and likely professionally as well. However, have you ever considered some of the negative aspects of lists?

Although this isn't new, I've been hearing more and more stories about formulary lists associated with prescribing patterns. I've heard of particular pharmacies that incentivize pharmacists to use certain medications (e.g., generics). I've also heard stories of pharmacists who suggest to patients that they should be using these formulary medications even when their prescribing doctor has indicated that they should not. This obviously creates an unfortunate situation; patients then return to their prescribing doctor, obviously upset that the doctor has prescribed a more expensive medication—having been informed by the pharmacist that the medications are virtually the same when clinically, the medications may very well not be the same.

I also keep hearing more and more about the idea of contact lens prescription formularies, which concerns me. There are significant differences among contact lens materials and among designs, and being forced into categories or specific lens types by a patient's vision care insurance provider, or a patient's desire for lower costs, can really create issues. How do we solve this? Well, I can't commit to knowing exactly how, but one thing that I think might help is for manufacturers to demonstrate scientific benefits of their products in clinically meaningful ways. Information that practitioners, and perhaps more importantly patients, can accurately and reliability understand based on the products' premium attributes.

So, while subscribing to a list can certainly be of benefit, living by the list may not always be the best bet when it comes to healthcare. Ultimately, are you prepared to add “maintain vigilance” to your practice to-do list?