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Creation and application of a value-based framework for formulary management.

Brandyn Wilcox1, Hetalkumari Patel1, Jerry James1

  • 1Department of Pharmacy, University of Texas Southwestern Medical Center, Dallas, TX, USA.

American Journal of Health-System Pharmacy : AJHP : Official Journal of the American Society of Health-System Pharmacists
|February 2, 2026
PubMed
Summary

A new value assessment framework (VAF) for medication formulary decisions demonstrated good overall inter-rater reliability. This tool showed excellent reliability for non-oncology drugs and moderate reliability for oncology medications.

Keywords:
evidence basedformularyframeworkgradinghigh-cost medicationsvalue assessment

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Area of Science:

  • Health Services Research
  • Pharmaceutical Policy
  • Drug Evaluation

Background:

  • Formulary decision-making requires robust frameworks to ensure value.
  • Existing methods may not fully capture institutional priorities.
  • A standardized approach is needed for consistent medication evaluation.

Purpose of the Study:

  • To develop and validate a novel value assessment framework (VAF) for oncology and non-oncology medications.
  • To assess the inter-rater reliability of the VAF at UT Southwestern Medical Center (UTSW).

Main Methods:

  • Developed a VAF incorporating institutional priorities and literature examples.
  • Selected six criteria: efficacy, safety, novelty, evidence quality, cost, and logistics.
  • Conducted a retrospective review of medication monographs (Oct 2021-Oct 2024).
  • Evaluated inter-rater reliability using the intraclass correlation coefficient (ICC) among three reviewers.

Main Results:

  • The UTSW VAF achieved good overall inter-rater reliability (ICC=0.75).
  • Excellent reliability was observed for non-oncology medications (ICC=0.80).
  • Moderate reliability was found for oncology medications (ICC=0.63).
  • Individual criteria demonstrated moderate to excellent reliability.

Conclusions:

  • The developed institution-specific VAF is reliable for medication formulary review.
  • The framework exhibits good overall reliability, with varying levels across drug types.
  • The VAF provides a structured approach to assessing medication value for formulary decisions.