Formulary evaluation using a class review approach: experience and results from an academic medical center

Developing and maintaining a drug formulary is an essential process that allows hospitals to meet mandatory standards, such as those defined by The Joint Commission, while ensuring that drugs are being used in a safe, appropriate, and cost-effective manner. In this article, we describe our strategy for an annual formulary review, the first year's results of its implementation, and its ongoing development at an academic medical center. Our strategy for reviewing the formulary was based on two main components-a scheduled class review (CR) process and a continuous safety-review process. After the first year of implementation, the pharmacy and therapeutics (P&T) committee reviewed 17 drug classes. The CR and safety review processes led to three formulary additions, 15 deletions, five new therapeutic interchanges, and six drug-safety issues requiring action. Cost-savings opportunities also resulted from using lower-priced generic medications and alternative product formulations. Institutional strategies to address the annual formulary review requirements can be accomplished via several methods, including the drug CR process. This process should be routinely evaluated and modified with the potential to provide additional institutional drug use evaluation benefits and to incorporate efficiencies as needed.