Pharmacy and Therapeutics Committee and Formulary Considerations

Exceptions to the Formulary

-A process is developed for prescribers to request a drug not on the formulary if it is medically necessary for a patient -Hospital setting: non-formulary request -Managed care setting: prior authorization

Creating a meeting agenda and holding a meeting

-Call to order by chairperson -Vote to approve minutes from previous meeting -Order of business on agenda (presentation of monographs or drug use evaluations done by pharmacist, requesting physician may be present) -Vote on proposals to add drug to formulary (requesting physician is excused from voting process) -Also vote other changes to policy and procedure

P&T Committee

-Composed of healthcare professionals responsible for creating, modifying, and implementing all policies on drug use -Main responsibility: managing the formulary system -Set number of members with voting privileges: select number of "yes" votes are needed to approve a proposal

After the meeting, the Committee Secretary will:

-Create meeting minutes -Disseminate information on decisions made during the meeting to healthcare providers of the institution -Implement policies and procedure changes and perform necessary staff education -Prepare for the next meeting

Formulary Additions

-Drug review should be unbiased and based on scientific literature -Formal drug review or drug monograph should be accompanied with full references -This is usually prepared and presented to the P&T by the pharmacist or pharmacy student -This is a way for HCPs to get information on unbiased data for the drug and how it may impact clinical practice in treating patients -Comes to a vote

Therapeutic Alternatives

-Drugs that are chemically different -Similar therapeutic effect and safety profile when administered in therapeutically equivalent doses -Pharmacists are allowed to use in place of nonformulary drug without having to contact the prescriber

Formulary: Purpose

-Ensure safe, appropriate, and cost-effective use of drugs in patient care for the healthcare facility -Provides guidance on what medications should be routinely stocked in the pharmacy -Can be used in hospitals, long-term care facilities, managed care companies, and medicare/medicaid

P&T Purpose

-Ensure safe, effective, and cost-effective use of drugs for patients in the hospital -Develop policies on evaluation, selection, and therapeutic use of drugs -Develop educational programs for professional staff

How is the formulary developed and managed?

-Every healthcare organization has its own process for developing and managing its formulary -The P&T committee responsible for developing, managing, and implementing the formulary system -Automatic therapeutics switch policy -Prescribing restrictions

Decisions to add or remove a drug on the formulary is based on:

-Evidence-based clinical data -New FDA indication or restriction -Drug safety data -Ethical and legal issues -Social impact and patient QOL -Physician prescribing habits -Cost-effectiveness Info often presented as a monograph to the P&T

Responsibilities of P&T committee

-Formulary management -Policies and procedures pertaining to drug use -Patient safety and quality assurance -Medication use evaluations -Medical staff and administration advising and education -Monitor adverse drug reactions

Conflicts of Interest

-Members of P&T and the HCP requesting drug addition to formulary should disclose any financial relationships with pharmaceutical companies and other commercial interests -Some hospitals do not allow persons with COI to be members of the P&T or restrict their role to discussion only, no voting privileges -Drug reps are not allowed to request formulary additions

P&T Other responsibilities

-Patient safety and quality assurance (med use evaluations) -Drug use criteria/restricted prescribing -Establish criteria for off-label uses -Monitor adverse drug events -Review policies and procedures pertaining to pharmacotherapy -Updates on clinical initiatives

P&T Chairperson

-Person who leads P&T committee meetings -Position usually held by physician

Members of P&T committee usually include:

-Physician of various specialties -Pharmacist: pharmacy director, supervisor, clinical, or staff pharmacists -Respiratory therapists -Nurses -Dieticians -Quality assurance personnel -Hospital administration personnel -Any professional involved in medication-use processes

P&T Secretary

-Responsible for developing meeting agenda and minutes and disseminating decisions made by P&T to the institution -Position usually held by pharmacist -The secretary and other pharmacists on the committee may be responsible for preparing drug evaluations

P&T Meeting

-Setting the agenda and supporting documents -Running the meeting -Post-meeting follow ups

JCMC Closed Formulary

-Valsartan (Diovan) is the ARB of choice on formulary -Other ARBs ordered are automatically switched to valsartan equivalent dose, as determined by P&T committee -Several HIV drugs of the same class are available on formulary due to clinical practice of treating the disease

What is a formulary?

A continually updated list of medications and related information, representing the clinical judgement of physicians, pharmacists, and other experts in diagnosis, prophylaxis, or treatment of disease and promotion of health

Combined Formulary

Limits prescribing choices in some therapeutic classes, but unlimited options within others

Open Formulary

Offers all commercially available products

Closed Formulary

Offers specific medications in each therapeutic class-providers must prescribe according to formulary