In: Health22 May 2010
Challenges in Formulary Management Across Patient Populations and Practice Settings
Moderator: Perry Cohen, PharmD, The Pharmacy Group, LLC, Glastonburg, Connecticut.
Representatives from diverse practice settings described their process for formulary management within their individual practice settings.
Speaker: Joseph B. Fox, MD, Vice President, The Healthcare Group
The Healthcare Group, a provider-owned regional health plan, develops and maintains direct relationships with employers. The group maintains and nurtures a close relationship with health care providers and sustains an adequate market share in Indiana and the surrounding region to preclude unacceptable influence by national carriers. canadian pharmacy viagra
The pharmacy program is primarily for a health maintenance organization (HMO) product and is a partner with Prescription Solutions. The group has a connection to network hospitals for chronic disease care.
The P&T process consists of a subcommittee that meets monthly and makes recommendations to the full committee. The P&T committee’s first step in the evaluation process is the clinical component; this is followed by the contract strategy. The Healthcare Group and Prescription Solutions have successfully grown and have maintained market share through an ongoing complex marketplace.
Speaker: Mary Inguanti, RPh, MPH, Vice President for Operations, St. Francis Hospital, Hartford, Connecticut.
The Drug Therapy Management Committee of the hospital, formerly the P&T committee, is supported by seven clinical subcommittees (oncology, antibiotics, dialysis, anesthesia, psychiatry, medicine, and cardiology) and has been successful in attaining its clinical and fiscal goals. The configuration of the subcommittees (physicians, pharmacists, nurses), by clinical area of excellence and by choosing an effective physician chairman, has worked out well. The subcommittee functions consist of class reviews, disease management, specific formulary recommendations, reviews of trends in adverse drug reactions, computer screen changes, national issues, and treatment algorithms.
The subcommittee identifies disease-management strategies associated with high drug expenditures, evaluates the clinical literature and confirms best practices, reviews drug expense data, and considers opportunities for practice change.
A new drug admission process, a nonformulary drug process, and a process that reviews critical issues (e.g., IV to oral conversion and changes in antibiotic selection) are now in place.
The clear delineation of the subcommittee’s functions and responsibilities (including the fiscal impact)—along with multi-disciplinary composition, strong pharmacy membership, and solid physician leadership—has effectively improved the formulary process at the hospital.
Speaker: Lynn L. Franzoi, Senior Vice President, Fox Entertainment Group, Inc.
Fox has implemented a disease-management program using drug treatment programs that will affect company costs, employee satisfaction, and worker productivity. Known as CareSupport, the program attempts to understand an employee’s medical condition, coordinate health care treatment, and manage his or her medication; this results in happier and healthier patients. Other goals are to decrease hospital stays, lower the costs of visits to specialty physicians, and monitor patients with chronic conditions and encourage their compliance with treatment plans.
The Fox program includes Drug Utilization Review (DUR), which identifies individuals who meet specific criteria for treatment and then recommends appropriate drug therapies. The DUR specifies the agents that are medically necessary, with the goals of lowering drug costs and reducing the incidence and expenses of medical services that result from drug-drug interactions, adverse drug effects, and patient noncompliance with prescribed therapies.
At Fox, the highest payout in 2003 was $561,864 to treat depression (6,697 claims by 1,131 members) with selective serotonin reuptake inhibitors (SSRIs), and $555,733 to treat high cholesterol levels (5,847 claims by 855 members). The preferred brands were Pfizer’s Zoloft generic (sertraline drug) and (atorvastatin calcium).
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