Inpatient Formularies Flashcards
1
Q
Formulary Goal
A
- Safe medication
- Efficacious/cost effective
- Estimated use, MD request/demand
2
Q
Voting Members
A
- Medical staff
- Few pharmacists
- Quality
- Nursing
- Dietary
3
Q
Pharmacist Role
A
- Way to affect the health care of patients at once
- Cost is not the only deciding factor when looking at formulary decisions for the hospital
4
Q
P&T - Formulary Decisions
A
- Add to formulary/more then one formulary
- Limit availability
- Protocols/order sets
5
Q
P&T - Quality/efficacy
A
- Policies and procedures around medication use
- Medication class reviews
- Medication utilization reviews (MURs)
6
Q
P&T - Cost/Utilization
A
- Track non formulary usage
- Therapeutic interchanges (IV to PO)
7
Q
Why have a P&T committee?
A
- Hospital reimbursement is based on DRGs
- Medicare groups together diagnoses via ICD-10 codes
- Illness severity determines payment rate
- NOT day based
- If readmitted for same diagnoses within 30 days, hospital is penalized
8
Q
Joint Commission
A
- Develop written criteria for formulary medications: effectiveness, drug interactions, safety
- Newly added meds must be monitored for safety/efficacy
- Formulary is available
- Process to procure medications not on formulary
- Formulary is reviewed annually
- Process to communication drug shortages
9
Q
Formulary Statuses
A
- On formulary
- On formulary with restrictions
- On formulary - not stocked
- Not on formulary
- Not added but will allow under special circumstances
10
Q
Formulary Exceptions
A
- Rare disease
- Patient stabilized on non-formulary med
- Conflict with outpatient formulary
11
Q
Evidence-Based Decisions
A
- Formulary additions must be evidence-based, not “in my experience”
- New is not better
- Must consider conflict of interests
12
Q
Managing Costs
A
- IV to PO
- Therapeutic interchanges
- Limit use of medications to specific specialty providers: helps antimicrobial resistance and keeps specialty meds in specialties
- Automatic stops
13
Q
Biosimilar Substitution
A
- Not a generic: procedure in place for automatic substitution in hospital
- Outpatient use driven by MCP
- Patients will get different products
14
Q
Biosimilar Controversies
A
- Immunogeneicity
- Extrapolation
15
Q
Effective Formulary Management
A
- Use MURs to determine if med/drug class is used appropriately: especially if added with restrictions
- Must be proactive, criteria based and systematic: goal to improve outcomes
- Criteria for eval: reecnt addition, med posing a health risk, expense
16
Q
Follow-Up
A
- Educate staff/providers
- Change criteria if needed
- Let staff know they are doing a good job
17
Q
Off Label Use
A
- Innovative off label use with rational thought behind medication working is acceptable
- Need to have a set procedure including rationale, pharmacological sense, safety, and monitoring
