CHANGES IN THE MAKEUP OF P&T COMMITTEES
Every day, decisions about which drugs to accept into a health plan or onto a hospital formulary, issues surrounding their coverage, and the level of co-pays, deductibles, and coinsurance affect physicians, pharmacists, and patients. The composition of P&T committees is changing to meet their increasing demands and responsibilities. These committees were originally composed primarily of physicians and pharmacists. Today’s committees utilize the assistance of numerous physician-specialists and experts and include input from various advisory subcommittees. Some organizations are also adding health care ethicists, economists, and geneticists to their P&T committees (Table 1).
The role of pharmacists on P&T committees has evolved as well. Many health plans and pharmacy benefit managers (PBMs) also seek to add pharmacist-representatives from both independent and chain-store pharmacies in their net works. The number of pharmacists on these committees has grown dramatically over the years; today, pharmacists make up about 30% of members on the average committee.
Table 1 Trends in the Responsibilities of P&T Committees
|Attribute or Task||Description|
|Composition and size||• The P&T committee should be composed of the following voting members, at a minimum: physicians, pharmacists, nurses, administrators, quality assurance personnel, and others as needed.• Experts (nonmembers) should be invited as needed to contribute their unique or specialized knowledge, skill, or experience.
• Size is determined by the scope of services provided.
|Chair and secretary||• The chairperson is appointed from among the physician staff. •A pharmacist is designated as secretary.|
|Meeting schedule||• The committee meets regularly, at least six times per year and more often if necessary.|
|Agenda and minutes||• Beforehand, an agenda that includes pertinent reading materials should be distributed to committee members, who should be given sufficient time to prepare for the meeting.• The secretary should prepare the minutes of the meeting, and they should be maintained in a permanent record.The minutes of the previous meeting should be distributed with the current agenda.|
|Committee recommendations||• Committee recommendations should be presented to the medical staff, or its designee, for review and comment or adoption.|
|Formal liaison||•A liaison should be maintained with other organizational committees that are concerned with medication use.|
|Communication||• All actions recommended by the committee should be routinely communicated to the appropriate health care personnel.|
|Ensuring credibility||• The organization and operation of the committee should ensure that recommendations are objective and credible. A conflict-of-interest policy should be established.• The committee should stay current with respect to setting standards and to professional organizations’ changes to guidelines and policies.|
Part of the reason for such an increase is that pharmacists have the necessary expertise and are best able to analyze and evaluate the choices and put them in the appropriate context for the committee’s members. Pharmacists are also in the best position to recommend drugs to be included at the appropriate level in a tiered benefit setting. This is of critical importance, because the appropriate tier placement of the selected drug determines the amount of co-payment or coinsurance to be paid by the health plan’s members. The level of co-payment or co-insurance can have a dramatic effect on the utilization mix of some drug categories. canadian antibiotics
According to two studies, an increase in patient cost sharing resulted in reduced drug-utilization rates. In the first study, the authors concluded that after the introduction of prescription drug cost sharing, the use of essential medications decreased by about 9% in elderly patients and the use of less essential agents dropped by approximately 15%. In the second study, an increase in patient co-payments was associated with fewer prescriptions dispensed per visit. With increasing cost sharing, members are more likely to take a more active role with their prescribing physician in determining which prescriptions they receive when choices between therapeutically similar agents need to be made.
Table 2 Current Structures and Functions of P&T Committees
|Size and composition||•Average of 19 members;dominated by physicians (average, 12 members)|
|Committee meetings||•Average about one meeting per month, between 60 and 90 minutes in duration|
|P&T subcommittees||• Most P&T committees are supported by several subcommittees that review a specific medication class and make recommendations to them|
|Committee activities||•Formulary management• Drug-use policy-making
• Drug-use monitoring
|Data from Nair KV, Coombs JH,Ascione FJ. P&T 2000;25(10):516-528.5|
One key issue that will profoundly affect the future structure of P&T committees will be the growth in the availability and importance of outcomes studies in the evaluation of medications to be added to or subtracted from their formularies. P&T committees rely heavily on the pharmaceutical industry for these studies. Today, despite the need for outcomes studies, they are not as readily available as they should be, partly because pharmaceutical companies do not have an endless budget with which to perform these studies. Further, in this highly competitive market, they have not had the luxury of time to invest in such studies. That said, the growing emphasis on the need for outcomes data would result in the greater availability of such studies over time.
Another key factor to be considered in the role and structure of future P&T committees is the inclusion of a pharmacy benefit for Medicare beneficiaries. The Medicare Modernization Act (MMA) of 2003 states that these pharmacy benefits are to be handled by private PBMs that use formularies and other utilization-management tools to control costs and optimize resources (Table 2).