Formulary management as a tool to improve medication use and gain physician support

Abstract

Q: Physicians can be resistant to formulary management activities focused on reducing pharmacy costs. What can be done to institute needed formulary changes and garner physician support for those actions? A: Historically, hospital pharmacy and therapeutics (P&T) commit- tees have focused principally on cost minimization.1 In this context, formulary management processes, characterized by prescribing restrictions, therapeutic interchanges, and protocols, guide use toward more cost-favorable drugs. Because of an exclusive focus on cost containment and the scrutiny by nonphysician personnel used in such processes, resistance can be elicited by physicians who think P&T committees are responsible for diminishing physician autonomy and authority. 2 Optimally, formulary management should provide quality for patients through the selection of medications that maximize value relative to costs and by making physician involvement integral throughout the process. Formulary management can be used as a way of providing quality and value through its strategies and mechanisms that create efficiencies in the medication-use process (therapeutic interchange) and that guide prescribing physicians (restrictions and guidelines).