Pharmacy formularies in integrated health systems.

Area of Science:

• Health Services Research
• Pharmacy Administration
• Integrated Health Systems

Background:

• An Oklahoma integrated health system faces challenges in establishing unified formulary management.
• The system includes 14 acute care facilities, medical practices, and a health maintenance organization (HMO).
• Current pharmacy and therapeutics (P&T) committee activities are decentralized at the individual hospital level.

Purpose of the Study:

• To describe the formulary management implications for a developing Oklahoma integrated health system.
• To identify challenges and progress in standardizing drug use across system entities.
• To assess the impact of current structures on formulary strategies and drug utilization.

Main Methods:

• Descriptive analysis of the organizational structure and existing formulary practices.
• Identification of key stakeholders and decision-making processes for drug formularies.
• Examination of current drug use influences for inpatient and ambulatory care settings.

Main Results:

• A systemwide pharmacy director position is pending; a regional operations management role has been created.
• Physician groups are forming to address system-wide P&T committees and formulary strategies.
• Inpatient drug use is influenced by the largest hospital's guidelines, while ambulatory care is managed by an external pharmacy benefit manager (PBM).

Conclusions:

• Significant challenges exist in coordinating formulary efforts between the health system and external entities like the PBM.
• Despite challenges, some standardization of drug use has commenced, aided by shared purchasing and information systems.
• Further development of system-wide P&T committees and formulary strategies is crucial for optimal integrated health system management.