ABOUT P&T COMMITES

THE IMPORTANT ROLE OF THE P&T COMMITTEES

P&T committees began in hospitals in the early 1960s as an effort to maximize rational drug use through the careful consideration of a product’s safety and efficacy. Their existence became mandated by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) in 1965. In the early 1980s, managed care adopted the use of a P&T committee to create drug formularies for the outpatient setting. In these early days, the drug formulary was primarily created to designate preferred drugs based on safety, efficacy and cost and to obtain discounts or rebates from pharmaceutical manufacturers for these preferred drugs.

CHANGING COMPOSITION

There are now more than 54,000 P&T committee members participating in formulary and drug rationale decisions in health systems and managed care organizations around the country. The composition of P&T committees is shifting to meet the increasing demands of the P&T process. Committees that originally were comprised primarily of academicians, primary care physicians, medical directors and pharmacy directors now utilize the assistance of numerous specialist physicians and advisory subcommittees. As drug therapy becomes more complex and costly, some organizations are adding health care ethicists, economists and geneticists to their P&T committees to help make decisions about the most appropriate drug therapies for their members.

EXPANDED RESPONSIBILITIES

Growing pressure on P&T committees to control drug costs has greatly altered their decision-making dynamics. P&T committees face extraordinary moral, ethical and financial dilemmas. The process of evaluating formulary submissions now must take into consideration issues relating to safety, efficacy, pharmacoeconomics and health outcomes. Committees are asking manufacturers to demonstrate the value of their products through the submission of evidence-based outcome analyses. This effort is intended to break down pharmacy “silos” – a budgetary technique that focuses only on a drug’s impact on the pharmacy budget – to shift the focus of formulary deliberations toward evaluating a drug’s system-wide impact on resource utilization and medical costs.

IMPORTANT DECISIONS

P&T committee decisions impact significantly on all health care stakeholders – providers, patients, purchasers and manufacturers. Their recommendations may range from approval with no restrictions to rejection:

• Approve the product for use in the organization
• Continue use of the product based on demonstrated value and efficacy compared to new competitive products
• Restrict the product to niche use only
• Reject the product from formulary acceptance
• Replace the product from formulary, allowing a competitive product to take its place

PTS decision-makers require access to comprehensive information and the training necessary to make these important and complex decisions. The Society is here to help, but we need support from our member volunteers and corporate sponsors.