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P&T Committees Eye Quality of Life, Drug Interactions

Kate Traynor

A new survey has found that, apart from safety and efficacy, patient quality-of-life issues and the potential for drug interactions are the most common factors a pharmacy and therapeutics (P&T) committee considers when making decisions about the formulary.

Eighty-two percent of the survey respondents said their P&T committee "always" or "usually" factors the effect a drug has on patients’ quality of life into decisions about formulary inclusion and reimbursement. The same proportion of respondents also said the potential for drug interactions guides their committee's decision-making process.

The influence of a medication's use on total treatment costs is "always" or "usually" considered by 81 percent of the respondents' committees when they make a decision on formulary inclusion or reimbursement.

The survey’s findings were reported in the September issue of Formulary (PDF), which also sponsored the study, in an article written by two of the journal’s editors.

In addition to questions related to the formulary decision-making process, the survey gathered data on the characteristics of the P&T committees. On average, a P&T committee has 13 members, with voting members serving the group for an average of four years.

Eighty percent of respondents said that "pharmacy/formulary directors" exert "much" influence over the decision-making process. Sixty-four percent said "staff/participating physicians" have this degree of influence, and 49 percent said medical directors are this influential.

Clinical pharmacy specialists were said by 47 percent of the respondents to have "much" influence on decisions made by the committee. But 34 percent of the respondents said there is no clinical pharmacist on their P&T committee.

Half of all the survey respondents from managed care organizations (MCOs) and 14 percent of those from hospitals and health systems said their P&T committee's membership includes at least one pharmacoeconomist.

Fourteen percent of the MCO respondents and 2 percent of the health-system respondents said a pharmacogenomist serves on the P&T committee. But 11 percent of the health-system respondents and none of the MCO respondents said their employer plans in the next two years to add at least one pharmacogenomist to the P&T committee.

Eighty-two percent of the survey respondents said their P&T committee is or soon will be responsible for monitoring and reporting adverse drug reactions and medication errors. Judgments about formulary inclusion and reimbursement, mentioned by 80 percent of the respondents, is the next most commonly cited responsibility of the P&T committee.

Other responsibilities, cited by more than 70 percent of the respondents, are the creation or review of treatment guidelines and protocols, crafting of medication-use policies to meet federal or regulatory standards, and performance or approval of drug-use evaluations. The monitoring of concerns about patient privacy, a duty mentioned by 17 percent of the respondents, was at the bottom of a list of 17 P&T committee responsibilities.

The survey, which was conducted this past March and April, was divided into three "subsurveys," each of which contained a different set of questions. Each subservey was mailed to 1,000 randomly selected Formulary subscribers. Survey respondents were entered into a random drawing for a single $500 cash prize. The overall response rate was 30 percent.

Karen L. Sprague, one of the report’s authors, cautioned that the survey data were not subjected to a robust statistical analysis. In their report, Sprague and her co-author described the survey as a "snapshot" of the formulary decision-making process in the United States.