Episode 10. Formulary Management with Oscar Santalo

Definitions

1. Formulary medication – A determination that the medication is “appropriate for routine use” in select patient populations
   1. Per 2008 ASHP Guidelines on the Pharmacy and Therapeutics Committee and the Formulary System
2. Pharmacy and Therapeutics (P & T) Committee – establishes policy development, communication, education, and formulary management

Background

1. How most hospital/health systems define formulary is: product readily available or stocked in the pharmacy
2. The environment surrounding hospital pharmacies has changed dramatically. The cost of pharmaceuticals, the types of newly approved medications for specific disease states, and the stipulations related to the reimbursement or procurement of medications have all been significantly altered.
3. Medication Use Evaluations or Drug Utilizations Reviews are a formal process that aid in the evaluation of medication formulary decisions
4. When evaluating a drug for formulary addition, the following factors need to be taken into account:
   1. Procurement and regulatory restrictions, economic considerations, safety & regulatory risks

Major End Points

1. Factors influencing formulary management decisions
   1. Cost, reimbursement, availability, specialization of medications (niche)
2. Can have different sub-committees roll into or feed up to P&T
   1. Subcommittees include medication safety, quality, antimicrobial stewardship, adverse drug reaction, biotechnology subcommittee
3. Instead of having formulary and non-formulary designations, we can expand this to include:
   1. Formulary, stocked
   1. Formulary, not stocked (or not consistently stocked)
   1. Formulary, restricted
   1. Formulary, requirement for confirmation of benefits of coverage prior to use
   1. Formulary, outpatient (or clinic) use only
   1. Non-formulary, stocked
   1. Non-formulary, not stocked
4. Post formulary decision implementation strategy plays a significant role in deciding the success or failure of that formulary decision
   1. It is equally important as the building up towards the P&T Process

References

Heindel GA, McIntyre CM. Contemporary challenges and novel strategies for health-system formulary management. Am J Health Syst Pharm. 2018 Apr 15;75(8):556-560. 

Leonard MC, Thyagarajan R, Wilson AJ, et al. Strategies for success in creating an effective multihospital health-system pharmacy and therapeutics committee. Am J Health Syst Pharm. 2018 Apr 1;75(7):451-455

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