AMCP Presentation

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AMCP Presentation

• Maria G. Tanzi, PharmD.
• Drug Information and Statistics
• September 29, 2005
• mtanzi1_at_uic.edu

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Drug Policy Management

• Purpose to ensure that medications are used
  safely and appropriately within an institution

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Pharmacy and Therapeutics (PT) Committee

• Definition A multi-disciplinary committee that
  advises medical staff and hospital administration
  on matters relating to the therapeutic use of
  drugs

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PT Committee

• Primary Objectives
• Organizational line of communication between
  medical staff and pharmacy
• Policy development
• Education

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PT Committee

• Members
• Physicians
• Pharmacists
• Nurses
• Administrators
• Quality-assurance coordinators

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PT Committee

• Organization
• Chairperson
• Respected member of medical staff
• Familiar with and advocate for progressive
  pharmacy
• Effective ally for pharmacy with medical staff
  and hospital administration
• Secretary
• Director of Pharmacy
• Sets agenda with chairperson

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PT Committee

• UIC Organization
• Meetings
• Meets monthly
• Meets every second Tuesday of the month for an
  hour or so
• 11 voting members
• 5 physicians
• 4 pharmacists
• 2 nurses
• Conflict of interest policy should be established

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PT Committee

• Organization
• Agenda
• Distributed 1 week prior to meeting
• Reminder and time to review
• Focus on multidisciplinary issues
• Contains drug monographs, adverse drug reaction
  reports, and policy changes

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PT Committee

• Organization
• Follow-up
• Actions should be conveyed to all health-care
  professionals
• Recommendations are to be passed on to the
  appropriate committee

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PT Committee Functions

• Formulary Management
• Drug Policy Management
• To ensure medications are used safely and
  appropriately within an institution
• Establish programs and procedures
• Adverse drug reactions
• Medication use evaluations

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PT Committee Functions

• Educational activities
• Quality Improvement Programs
• Drug distribution and control

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PT Committee Functions

• Pharmacy Specific Functions
• Agenda
• Preparation
• Education

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Formulary Management

• Formulary
• Definition a continually revised compilation of
  pharmaceuticals that reflects the clinical
  judgment of the medical staff

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Formulary Management

• Formulary system management
• Definition method where the medical staff
  working through the PT committee, evaluates,
  appraises, and selects from the numerous
  available drug products those considered most
  useful in patient care

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Formulary Management

• Formulary system management
• Theory a well designed formulary can guide
  physicians to prescribe the safest and most
  effective agents for treatment of a particular
  condition.

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Formulary Management

• Objectives
• Decrease drug cost
• Assure high quality care
• Provide information on drug products
• Provide information on organizational
  policies/procedures
• Development of institution specific
  guidelines/protocols

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Formulary Management

• Purpose for ongoing management
• Removal/addition of drugs from/to the market
• Changes in hospital policies/procedures
• New clinical information available
• Clinical trials
• Guidelines
• Safety

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Formulary Management

• Advantages
• Ensure quality and appropriateness of drug use
• Educational for staff regarding most effective
  agents
• Economic benefits

• Disadvantages
• Only reduces cost
• Compromises patient care
• Limits physician prescribing authority

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Formulary Management

• Principles
• Drug product selection
• Comparison of all aspects of an agent to that of
  similar medications.
• Should be based on scientific evidence
• Consider effectiveness, safety and cost

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Formulary Management

• Principles
• Formulary Maintenance
• Addition/deletion
• Newly approved agents
• New information available (i.e. safety, efficacy)
• Tracking use of nonformulary agents
• Single drug review
• Compare single drug to other drugs that are
  similar
• Focus is on a single drug
• Therapeutic class review
• Compares/contrasts all the agents in a single
  class
• Focus is not on a single drug

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Drug Product Selection

• Development of a drug monograph
• Purpose to evaluate various medications to
  ensure that patients receive drugs that are
  safe,therapeutically effective and cost effective

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Drug Product Selection

• Development of a drug monograph
• Preparation
• Identify drug to evaluate
• Determine if there are similar agents on
  formulary
• Obtain background information
• Clinical and safety information
• Indications
• Cost
• Clinical trials

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Drug Product Selection

• Development of a drug monograph
• Components
• Summary page
• Introduction
• Pharmacology
• Pharmacokinetics
• Clinical efficacy

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Drug Product Selection

• Development of a drug monograph
• Components (cont)
• Adverse effects
• Drug Interactions
• Cost and dosage
• Conclusion/Recommendations
• References

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Drug Product Selection

• Points to consider addition to formulary
• Clinical effectiveness, safety, and cost
• Comparison to similar agents
• Comparison to standard therapies
• Advantages/disadvantages
• Niche

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Drug Product Selection

• Therapeutic Interchange
• Definition interchange of various TE drug
  products by pharmacists under pre-defined
  arrangements with the prescriber

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Drug Product Selection

• Therapeutic interchange
• Elements for successful implementation
• PT approval
• Scientific/clinical evidence
• Medical staff education
• Mechanism to implement interchange
• Maintenance

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Drug Product Selection

• Therapeutic interchange process
• Substitute generic for brand
• Give individual agents in place of combination
  product
• Switch from intravenous to oral antibiotics
• Change to different agent in same class
• Interchange may be automatic or may require
  notification

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Therapeutic Interchange

• Advantages
• Reduced inventory
• Hospital saves money
• Encourages compliance with formulary

• Disadvantages
• Confusing to patients
• Patients may think that drugs are NOT equally
  effective
• Preferred product may change based on contracts

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Illinois Department of Healthcare and Family
Services (IHFS)

• Role of the Drug Information Center
• Preparation of monograph or class review
• Development of prior authorization criteria
• Input on new drug approvals
• Response to changes in market
• Prior authorization activities (future)

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Illinois Department of Healthcare and Family
Services (IHFS)

• Preferred Drug List (PDL)
• Preferred Drug List in the Atypical Antipsychotic
  and Anticonvulsant Classes
• Three-Brand Name Drugs Limit
• Prior Approval Form for Synagis Requests
• Over-the-Counter NDCs No Longer Covered for
  Adults Age 21 and Over

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Illinois Department of Healthcare and Family
Services (IHFS)

• http//www.hfs.illinois.gov/preferred/

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Drug Information CenterManaged Care Clients

• UFCW
• Wellpoint
• Blue Shield of California
• BC/BS of New York
• WHI
• MC-21
• UIC Medical Center

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PT Competition

• What does it do for me?
• Greater understanding of literature evaluation
• Jump start or review of drug information skills
• Improve on public speaking
• Learn how to work with a team

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Questions