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PubMed1996

Formulary: what it is and how it works.

Estimates for healthcare expenditures in 1993 exceeded $900 billion, approaching 15% of GNP. Of this, approximately 7.5% ($62 billion) was spent on drugs. More recently, costs show that the US spends over $3,000 per person per year on healthcare. Although no one disputes that the cost of healthcare is rising, generally the rate at which it rises is not as rapid in a managed care environment compared to a fee-for-service one. Because of this, the boundaries of managed care and pharmacy benefits management (PBM) continue to expand. Outpatient drug benefits, for instance, are being carved out of the medical benefit offered by several types of insurance programs. This is mainly a result of point-of-sale claims processing and enhanced information system data base reporting making the drug portion easier to identify and separate from other medical claims. Self-funded employers are now actively seeking PBM companies to contract with for this type of service. The services being offered by PBM companies include: Pharmacy networks in which plan members fill prescriptions at a discounted or contracted rates. Disease state management. Drug utilization review. Financial reporting. Formulary management. The main component of formulary management is the development and distribution of a drug formulary. This article discusses what a drug formulary is and how it works.

Cost-Benefit Analysis↗
PubMed1996

Formularies in integrated health systems: Sharp HealthCare.

Formulary management implications are described for a California health system comprising 7 hospitals, 4 skilled-nursing centers, 22 medical clinics, 8 urgent care facilities, and a health maintenance organization. Sharp HealthCare serves nearly one million people in the San Diego area. A single institutional care division (ICD) pharmacy service has been created under the guidance of a steering committee comprising a pharmacy operations coordinator and a staff pharmacist from each site, the system pharmacy director, the system senior pharmacy information systems specialist, and the system senior clinical pharmacy specialist. Operations at each site are overseen by an operations coordinator instead of a pharmacy director. Functional teams reporting to the steering committee are standardized pharmacy processes, including formulary management; this is particularly important because the ICD has pharmacists and nurse per diem pools. Until 1995, formularies were independently managed at each site. Now, one system formulary is being developed. Standard policies and procedures, a nonformulary drug request form, and a monograph format have been completed. The hospitals' autonomous medical staffs have thus far elected to retain individual pharmacy and therapeutics (P&T) committees but approved a revamped formulary review process and system-wide P&T subcommittees. The computer system is being enhanced so that pharmacists will have access to applicable P&T committee-approved guidelines for drug use. Since vendors were advised that the system is establishing one formulary, Sharp has been able in some cases to achieve better pricing than it previously could through its purchasing group.

California↗
PubMed1996

Pharmacoeconomics: disease-based management applications.

Pharmacoeconomic information is rapidly becoming an accepted format for evaluating and comparing various treatment options. Such information may either supplement or replace standard methods for evaluating new drugs for possible inclusion on the formulary. It is important to recognize the pitfalls that may accompany different methods of collecting and evaluating pharmacoeconomic studies. Such information is important because drug use and outcomes in a real-world setting may differ substantially from those within the confines of a clinical trial setting.

Anti-Bacterial Agents↗
PubMed1996

Antibiograms.

In most hospitals, the results of countless cultures and sensitivities are summarized and reported in the form of antibiograms. The advantages and limitations of antibiograms must be considered when contemplating empiric therapeutic recommendations. Methods to optimally utilize this resource are described. Antibiograms may also be used to guide formulary decisions, although practically they are more useful in monitoring recent additions or deletions. Antibiograms that incorporate formulary, drug of choice, dosage, cost, and hospital-specific restrictions will facilitate patient-specific decisions.

Anti-Bacterial Agents↗
PubMed1997

Use of a geriatric formulary in long-term care.

The use of drug formularies in nursing facilities (NFs) is a fairly new idea. A large long-term care pharmacy provider prepared a formulary specific to a geriatric population. This open formulary is contained within a handbook of clinical monographs, complete with dosing information, cost comparisons, and references to NF regulations affecting the use of particular drugs.

Aged↗
PubMedDate not supplied

Pharmacy formularies in integrated health systems.

Formulary management implications are described for an Oklahoma integrated health system comprising 14 acute care facilities, numerous owned medical practices, and a fledgling HMO. A systemwide pharmacy director has yet to be appointed; however, the position of pharmacy operations management for the Oklahoma City area has been created. A physician group has been formed that is expected to address system-wide pharmacy and therapeutics (P&T) committees and formulary strategies. Currently P&T committee activities take place at the individual hospital level. The hospitals do not have restrictive formularies. An overall formulary system would likely be patterned after the largest hospital's system, including a formal approval process in which a P&T subcommittee reviews drug use outside established guidelines and the P&T committee asks the appropriate medical department to address the problem. For ambulatory care, the HMO has contracted with a pharmacy benefit manager (PBM), and there is no coordination of formulary efforts between the PBM and health system entities. Although this and other problems remain to be resolved, some standardization of drug use has begun. Also, all entities in the system use the same purchasing group and plan to use the same information system. Drug use among hospitalized patients in this integrated health system is influenced by the usage guidelines established at the largest hospital, and drug use among ambulatory managed care patients is influenced by an external PBM.

Ambulatory Care↗
PubMedDate not supplied

Choosing the right PBM.

A growing number of HMOs are turning to pharmacy benefit management firms to administer their prescription benefit programs. A consultant offers tips on how to evaluate PBMs and the services they provide.

Clinical Pharmacy Information Systems↗