amcp presentation

1. AMCP Presentation Maria G. Tanzi, PharmD. Drug Information and Statistics September 29, 2005 mtanzi1@uic.edu

3. Pharmacy and Therapeutics (P&T) Committee Definition: A multi-disciplinary committee that advises medical staff and hospital administration on matters relating to the therapeutic use of drugs

4. P&T Committee Primary Objectives Organizational line of communication between medical staff and pharmacy Policy development Education

5. P&T Committee Members Physicians Pharmacists Nurses Administrators Quality-assurance coordinators

6. P&T 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

7. P&T 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

8. P&T 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

9. P&T Committee Organization Follow-up Actions should be conveyed to all health-care professionals Recommendations are to be passed on to the appropriate committee

10. P&T 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

11. P&T Committee Functions Educational activities Quality Improvement Programs Drug distribution and control

12. P&T Committee Functions Pharmacy Specific Functions Agenda Preparation Education

13. Formulary Management Formulary Definition: a continually revised compilation of pharmaceuticals that reflects the clinical judgment of the medical staff

14. Formulary Management Formulary system management Definition: method where the medical staff working through the P&T committee, evaluates, appraises, and selects from the numerous available drug products those considered most useful in patient care

15. 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.

16. 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

17. 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

18. 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

19. 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

20. 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

21. 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

22. 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

23. Drug Product Selection Development of a drug monograph Components Summary page Introduction Pharmacology Pharmacokinetics Clinical efficacy

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

25. 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

26. Drug Product Selection Therapeutic Interchange Definition: interchange of various TE drug products by pharmacists under pre-defined arrangements with the prescriber

27. Drug Product Selection Therapeutic interchange Elements for successful implementation P&T approval Scientific/clinical evidence Medical staff education Mechanism to implement interchange Maintenance

28. 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

29. 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

30. 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)

31. 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

32. Illinois Department of Healthcare and Family Services (IHFS) http://www.hfs.illinois.gov/preferred/

33. Drug Information Center:Managed Care Clients UFCW Wellpoint Blue Shield of California BC/BS of New York WHI MC-21 UIC Medical Center

34. P&T 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

35. Questions