Lecture 2—What Is a Formulary, Anyway? (Or the Cliff Notes Version of Drug Stewardship and Expense Control)

Abstract

A formulary is the product of an evaluative process, the formulary system, conducted by an expert panel that both sanctions and guides the selection, prescription, administration, and monitoring of pharmaceuticals and related items for a given environment. An expert panel, often called the Pharmacy and Therapeutics Committee (P&T), is a group of pharmacists, physicians, nurses, and administrators assembled for the purpose of providing guidance and validation for pharmaceutical utilization in a given organization. Expert panels became prominent because of qualitative and quantitative changes in drug production and marketing strategies employed by industry, the expansion of public health sector medicine, and organized, macro-level drug control systems. It could be argued that, as a clinical instrument, the formulary is predicated on the role pharmacy is perceived to play in actual direct patient care. In this lecture, the concept and defining characteristics of a formulary (the perspective of an expert panel, differences in the environment of application, and interprofessional relationships), the modifiers used to describe a formulary, which modifiers enhance or distract from its meaning, and the outlook for comprehensive and objective evaluation through the formulary mechanism are discussed.

Clinical Utility and Cost Savings in Predicting Inadequate Response to Anti-TNF Therapies in Rheumatoid Arthritis

“…This study has the following limitations: (1) a sensitivity analysis was not performed on the model, (2) the cost savings model assumes that clinicians will change management of the patient when the patient does not respond to a medication within 6 months; however, retrospective data reveal that many inadequate responders to medications are kept on the same drug for longer periods of time, up to 18 months [ 52 ], (3) the model assumes that clinicians will prescribe with full adherence to the PrismRA test results, diverting patients who are not likely to respond to anti-TNF therapies to another MOA therapy, even though rheumatologists may be limited in doing so based on patient preference or payer formularies, and (4) the cost of PrismRA was not included in the model. Additionally, reported cost savings will depend on the price difference between the anti-TNF therapies and alternative MOA therapies used, which will differ based on formulary policies and use of biosimilars [ 53 – 55 ].…”