by Bonnie Lai, PhD

Sep 06, 2019

Transforming Clinical Pharmacy: Formulary Processes and Stakeholder Engagement

Despite years of advocacy from the American Society of Health-System Pharmacists and others, the role and effectiveness of pharmacy and therapeutics (P&T) committees continue to vary widely in practice.

For example, physicians often express frustration about not being consulted in formulary decisions, particularly when they’re not members of a P&T committee.

A spine surgeon at a Midwestern IDN recently lamented a decision to not allow him to use Exparel.

“As surgeons, we don’t get a good sense of why and who decides that,” he said. “My first reaction was that this decision must have been made to save money. I want someone to show me the research on patient outcomes!” He felt that he lacked crucial information due to poor communication and education around the policy. “I have no idea what [Exparel] costs, and what the alternatives are that are just as good.” 

At the same time, pharmacists often feel that physicians are not engaged in the P&T process.  This starts with an unwillingness by many physicians to participate in P&T meetings. A pharmacist might meticulously craft a 20-page, evidence-driven drug monograph only to find that physicians don’t read the information and that their eyes also glaze over five minutes into the P&T committee meeting. 

Highly effective organizations have found a simple secret to combat this disconnect: Ensure that most of the work happens outside of P&T committee meetings. Many physicians are extremely protective of any time not spent directly improving patient care, so health system leaders are finding ways to consolidate and streamline communications to meet physicians where they are. 

At Novant Health, a 15-hospital IDN based in North Carolina, great care is taken to prepare for P&T meetings. Identified stakeholders—representing different sites, service lines and specialties—provide their input weeks in advance. Pre-P&T meetings serve as dress rehearsals where clinical pharmacy specialists and residents practice presenting their materials and fielding questions.

“It is because of these investments in engaging stakeholders and preparing our team of pharmacists that our P&T process is highly effective,” says Christy Ciccarello, Vice President, Clinical Pharmacy Services at Novant. “We’re typically able to make twenty decisions in each monthly meeting.” 

At Asante, pharmacists have been mobilized to contribute to clinical improvement forums.

“My job requires outcomes,” says Amy Watson, Director of Pharmacy Service & Chief Pharmacy Officer.

For example, when Asante developed clinical pathways for heart failure, pharmacists were critical members of cross-functional teams that determined when to insert medications. Watson regularly reviews clinical, operational and financial outcomes measures in leadership meetings to gauge the effectiveness of these initiatives. 

By taking the lead in determining how to best involve physicians in effective evidence-based formulary management, pharmacy leaders can play a critical role in driving collaboration, eliminating frustration and ultimately improving patient care.