Background: Though The Joint Commission requires health systems perform annual formulary review, guidance for how to perform this review is lacking. Published methods include comprehensive review of all pharmaceutical classes; however, this approach may not be the most efficient or effective option for a health system with a large formulary. Objective: To create a prioritization system for annual formulary review through development of a pharmaceutical class scoring tool. Methods: Drug information pharmacists developed the scoring tool, which used external and internal data to score pharmaceutical classes in 4 categories: safety, efficacy, cost, and utilization. The primary outcome, number of formulary changes resulting from pharmaceutical class review, was compared between the highest-scoring and lowest-scoring class to assess the tool’s ability to prioritize high-yield class reviews. Results: The tool calculated scores for 91 pharmaceutical classes, altogether containing 962 medications. After review of the highest-scoring class, corticosteroids, 2 formulary changes were made: one dosage form was removed from formulary, and one medication was restricted to outpatient use only. Zero formulary changes resulted from review of the lowest-scoring class, pharmaceutical adjuvants. Conclusions: The tool described in this study prioritized annual formulary review efforts by identifying a pharmaceutical class with meaningful formulary optimization opportunities as the highest-scoring class, while correctly identifying a class with no optimization opportunities as the lowest-scoring class.

Introduction: Racial and ethnic inequity in pain management have been well documented in peer-reviewed literature. A recent publication suggested inequity in opioid prescription rates for Black and White patients among 310 large and racially diverse health systems, including Froedtert & the Medical College of Wisconsin (F&MCW).This prompted F&MCW to further investigate its own opioid prescription data. Pharmacists have led similar investigations to evaluate racial inequities in health care, and are well-positioned to assess opioid prescribing.Objective: To investigate opioid prescription inequity between Black and White patients treated by F&MCW. Methods:The pain stewardship pharmacist led a multidisciplinary team to collect and analyze ambulatory opioid prescription data for fiscal year 2021. Primary outcomes included number of prescriptions, minimum morphine equivalent daily dose (MinMEDD), and maximum morphine equivalent daily dose (MaxMEDD). The primary independent variable was the reported race/ethnicity in the medical record. Linear regression models for each outcome were performed first unadjusted, and secondly adjusted for patient demographics, complexity, and comorbidities.Results: A total of 122 738 prescriptions for 47 939 patients were analyzed. Using the unadjusted model, non-Hispanic Black (NHB) patients had a significantly higher number of prescriptions compared with non-Hispanic White patients