Hospital Pharmacy - October 2020 - 308

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Hospital Pharmacy 55(5)

Table 2.  Formulary System Management Techniques Used by the Hospitals.
Hospitals (N = 15)
 

n (%)

Using non-formulary prescribing data to generate Pharmacy and Therapeutics (P&T) committee discussion
about product
Identifying specific products that require prior approval before patient use
Systematically disseminating medication cost information to prescribers (eg included in printed formulary,
antibiogram, and drug information software)
Using clinical decision support in computerized prescriber order entry systems to guide formulary compliance
Using standardized order sets to guide formulary compliance
Comprehensively review at least two therapeutic categories each year
Other

8 (53.3)
8 (53.3)
7 (46.7)
7 (46.7)
6 (40.0)
3 (20.0)
3 (20.0)

Table 3.  Drug Policy Tools Used by Pharmacy and Therapeutics Committee to Improve Medication Use.
Hospitals (N = 15)
 

n (%)

Clinical practice guidelines that include medications
Restricting prescribing of certain categories of medications to certain specialties, or only with consultation
Comparing the effectiveness of products when making formulary decisions
Rationing of medications based on expected patient outcomes and cost of therapy
Traditional, restrictive formulary with a limited list of medications
Medication use evaluation
Formulary decisions made based on a rigorous pharmacogenomic threshold (eg cost-effectiveness
analysis, cost-benefit analysis, or cost-utility analysis)
Making formulary decisions based on package labeling (eg avoiding off-label use)
Therapeutic interchange
Protocols that transfer authority for product selection and dosing from prescribers to pharmacy

formulary with multiple products in each therapeutic category, and 6.7% preapproved therapeutic interchange to an
equivalent formulary product.
There are various drug policy tools used by P&T committees to improve medication use in their hospitals (Table 3).
Most commonly: clinical practice guidelines that include medications (86.7%), followed by restricting prescribing of certain
categories of medications to certain specialties, or only with
consultation (80.0%), comparing the effectiveness of products
when making formulary decisions (53.3%), rationing of medications based on expected patient outcomes and cost of therapy (53.3%), traditional, restrictive formulary with a limited
list of medications (46.7%), medication-use evaluation (MUE;
46.7%), formulary decisions made based on a rigorous pharmacogenomic threshold (eg cost-effectiveness analysis, costbenefit analysis, or cost-utility analysis; 40.0%), making
formulary decisions based on package labeling (eg avoiding
off-label use; 40.0%), therapeutic interchange (33.3%), and
protocols that transfer authority for product selection and dosing from prescribers to pharmacy (26.7%).
Pharmacy directors reported some drug policy issues
addressed by their P&T committee. The most common issue

13 (86.7)
12 (80.0)
8 (53.3)
8 (53.3)
7 (46.7)
7 (46.7)
6 (40.0)
6 (40.0)
5 (33.3)
4 (26.7)

was the process for managing drug product shortages
(60.0%), followed by purchasing of medications from
sources other than your primary wholesaler or direct from
the manufacturer (eg through the "Grey Market"; 53.3%),
outsourcing guidelines for compounded sterile products
(46.7%) rationing of limited supply drugs (40.0%), and 6.7%
of hospitals did not provide an answer. Most of the respondent hospitals' P&T committee meet mostly once a month
and 4 times during the year (26.7%).
Several sources are typically used to develop a presentation
and recommendation for the P&T committee, most commonly:
using drug information (eg American Hospital Formulary
Service [AHFS]/GOLD STANDARD/MICROMEDEX/UpTo
Date; 73.3%), pharmaceutical manufactures (66.7%), formulary monograph service/company (53.3%), PubMed search
(53.3%), Internet search engine (eg Google, Bing, and
Yahoo; 46.7%), wholesaler therapeutic review/monograph
(20.0%), Cochrane collaboration review (20.0%), and group
purchasing organization therapeutic review/monograph,
health-system/corporate/central office (13.3%).
Pharmacist actively provided consultations (Table 4),
mostly in drug information (80.0%) followed by dosage
Hospital Pharmacy - October 2020

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