It has been nearly 20 years since AMCP and other stakeholders adopted the Principles for a Sound Formulary System. Since that time, requirements for pharmacy and therapeutics committees (P&T) have been adopted by the Medicare Part D program, health insurance marketplace plans, commercial health plans, Medicaid programs, and other public payers. Changes and evolution in the health care system, including a focus on value-based care, suggest the need for updated recommendations from a broad stakeholder coalition. This Forum will provide a venue to consider P&T practices that reflect the current health care system and provide recommendations to allow for a transparent P&T process in today’s health care system.
While the perspectives of participants varied, several themes came to light:
- Variation exists in the guidelines and evidence cited in publicly available payer coverage decisions across therapeutic class and even for the same drug-indication pair.
- The wealth of new information and data sources available for evaluating the effectiveness of drugs and devices, will require additional competencies in new evaluation techniques and methodologies by P&T committee members.
- Managed care organizations have a huge opportunity to engage and incorporate the patient perspective in coverage decisions.
- Managing conflicts of interest and establishing organizational policies on transparency are crucial and should be a priority.