Formulary system management

ASHP Guidelines on formulary system management. Am J Hosp Pharm 49 648-652, 1992. 

Formulary system management falls into three general categories drug selection for formulary inclusion, formulary maintenance, and medication use evaluation. 

The actual process of managing the formulary system is different in each organization, but there is a common theme between the components that make up... 

The P T committee s primary function is to maintain a drug formulary. Pedersen et al. (2001) showed that 97.5% of hospifals reporfed fhaf formulary development and management was a primary function of a P T committee. However, key elements of managing the formularies are developing and implementing policies that assure safe and effective medication therapy within institutions. These elements were also reported as primary fxmctions by 97.1% of the hospitals surveyed. The following section reviews fhe formulary system and its management. 

Formulary systems are an essential tool used in a variety of settings including hospitals, ambulatory clinics, health plans, pharmacy benefit management companies, and government agencies. This tool, if used correctly, promotes rational, clinically appropriate, safe, and cost-effective pharmaceutical care. 

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. 

Responsibility for developing, maintaining, and enforcing formulary systems in managed care lies... 

Before moving from discipline-specific standards to a review process that focuses on a multidisciplinary and systems-based approach to care, medication standards were in department-specific chapters, such as pharmacy, nursing, and medical staff, with the latter centered arormd the Pharmacy and Therapeutics committee, the formulary and adverse drug reaction reporting. Over time, the pharmacy standard disappeared and was integrated into the overall patient care chapters. For the 2004 standards, the JCAHO has published a new chapter entitled Medication Management, which reflects increased focus on medication systems and safety. This chapter divides the medication process into six segments ... 

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. 

As a result of these observations, a variety of methods have been utilized to modify antimicrobial use in an effort to combat resistance. These include the use of an antimicrobial formulary, re.striction of agents, requirement of prior approval to obtain specific agents, multidisciplinary antibiotic management teams, and the use of computerized support systems. The impact of these programs on resistance is reviewed elsewhere,and one or more of these methods is being employed in many institutions. 

Pharmacists serve as members of the healthcare system s Pharmacy and Therapeutics Committee which directs the review process for considering medication additions to and deletions from the drug formulary. The committee may review and manage data from the ADR reporting program and from medication usage evaluations and reviews, and may monitor policies for medication use guidelines. 

The selection of pharmaceutical products based on a national formulary or on the essential medicines list is recommended. WHO s Model Formulary (15 and Model Essential Medicines List 4) identify the most cost-effective and affordable pharmaceutical products to treat prevailing health problems. They are updated regularly and are made freely available for adaptation by countries. The health systems of many industrialized and developing countries have used the essential medicines concept for decades to use existing resources effectively. Because the use of a national formulary reduces the number of products used, supply management activities and inventorycarrying costs are minimized. 

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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