Hospital Pharmaceutical Formularies differ from Insurance Company Formularies

[Hoyt]

9. Heck, nowadays it's becoming increasingly difficult to differentiate hospitals and insurers.

The are becoming one and the same. The ACA actually provides incentives for hospitals and/or physician groups to essentially become insurers and providers in what is called an Accountable Care Organization. Of course, integrated HMOs are essentially insurer and provider.

Even where that is not happening -- for those payers that don't pay a flat fee based upon diagnosis (like Medicare usually does for inpatient care), a hospital is definitely going to put drugs on its formulary that are usually covered by insurance companies. And the formulary definitely take costs into account when payment is made under a flat fee.