Formulary management

It is noteworthy that drug costs, and their impact, are perceived differently from different perspectives in the healthcare system. Each component of the healthcare system (hospital, home care, ambulatory provider) may have a different perspective on the cost of therapy. Hospitals are usually responsible for all drug-related costs (drug purchase, medication administration, laboratory monitoring, etc.) for the finite period of time that a patient is hospitalized. 

A stand-alone outpatient drug benefit manager might only worry about the drug cost for the nonhospitalized portion of the therapy. The overall health system may be at financial risk for all elements of outpatient and inpatient care. Because each element of the system may be responsible for a different component of the total cost of care, the cost-impact of a given drug product selection may be different for each element. The societal perspective often represents yet another view of drug costs in that it incorporates nonhealthcare costs and the value of lost days of work and disability. Formulary inclusion is not routinely based on that level of evaluation, but public policy may be influenced by that information. 

FIGURE 26.4 Financial perspective in formulary decision-making. Comparison of tw o treatment options 2-day cure at 400 per day versus 10-day cure at 100 per day, with an anticipated hospital stay of 3 days. 

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Formulary management Antibiotic restrictions Compliance with prescribing according to institution-specific guidelines... 

An emerging trend in formulary management is the decline in the utilization of enforcement and restriction strategies such as switch and prior authorization programs (Litton et al., 2000). These programs typically have high administrative and internal resource costs, significant time... 

Drug utilization review Pharmacokinetic monitoring Drug formulary management Pain management Drug research and studies Nutrition... 

Foulke, G.E. Siepler, J. Antiulcer therapy An exercise in formulary management. J. Clin. Gastroenterol. 1990, 12, S64-S68. 

The advent of electronic prescribing will decrease pharmacists roles in many areas. In dispensing roles, pharmacists will have less responsibility for order entry, PBM formulary management, and disease protocol adherence. Furthermore, a large number of DUR functions will be taken care of before the patient s order is received in... 

The development of a formulary system within an organization rests with a multidisciplinary committee. In the hospital and health system setting, this is typically called the P T committee. Virtually all hospitals and health-systems have a P T committee.P T committees usually meet six to eight times annually. An ASHP Position Statement on formulary management declares that decisions should be based on clinical, quality of life, and pharmacoeconomic factors that result in optimal patient care. - It advises against decisions solely based on economic factors. The Position Statement also recommends that decisions must include active and direct involvement of physicians, pharmacists, and other appropriate health care providers. This may include dieticians, nurses, administrators and quality management coordinators. 

Massoomi, F. Formulary management Antibiotics and therapeutic interchange. Pharm. Pract. Manage. Q 1996, 16 (3), 11 -18. 

Dillon, M.J. Drug Formulary Management in Managed Care Pharmacy Practice, Navarro, R.P., Ed. Aspen Publishers, Inc. Gaithersburg,. Maryland, 1999 145-165. 

In today s health care settings, pharmacoeconomic methods can be applied for effective formulary management, individual patient treatment, medication policy determination, and resource allocation. 

Pharmacoeconomic data can be a powerful tool to support various clinical decisions, ranging from the level of the patient to the level of an entire health care system. Figure 1-2 shows various decisions that may be supported using pharmacoeconomics, including effective formulary management, individual patient treatment, medication policy, and resource aUocation. For discussion purposes, the application of pharmacoeconomics to decision making is divided into two basic areas drug therapy evaluation and clinical pharmacy service evaluation. 

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