Are formal guidelines better than informal ones?
In theory, one might expect formal guidelines to improve upon informal ones because they promote the use of broader economic and health outcomes to inform decisions, and promise to foster a more careful deliberation about a drug’s overall value. Standardized guidelines might enable plans to streamline processes and lower administrative costs. However, these are not foregone conclusions. Whether plans prefer formal guidelines and standards will depend on their costs and benefits above existing practices. Whether and to what extent explicit guidelines will enhance efficiencies and improve patient care remains unclear and should be subject to further evaluation. Limited empirical evidence is available. Awareness of the AMCP Format among health plan managers appears high, although small studies suggest wide variation in plans’ adherence to the guidelines’ recommendations, as well as poor quality in submitted materials.13 Data on the guidelines’ actual impact on patient outcomes are lacking
