Formulary Management

AMCP recognizes the value of drug use review (DUR) as a means to understand, interpret, evaluate, and improve the prescribing, administration, and use of medications to improve patient outcomes and total cost of care. Using DUR information, managed care pharmacists can identify prescribing trends and initiate corrective action in collaboration with appropriate stakeholders to improve drug therapy for groups of patients, as well as individuals.

 
(See AMCP Concepts in Managed Care Pharmacy – Drug Use Evaluation).

Formularies

Policy 9910

11/01/1999 Introduced
02/01/2005 Revised
02/01/2010 Reapproved

02/08/2017 Revised

04/23/2018 Revised

03/25/2019 Revised

AMCP supports the use of appropriately designed formularies as quality-enhancing, cost-effective pharmaceutical care tool that meets the needs of the patient population and assist members of the health care team in effectively managing a patient's total medical care regimen. Formulary coverage decisions are based primarily on sound clinical evidence. Cost should be considered only after safety, efficacy, therapeutic need and patient outcomes have been assessed. The value of a formulary is maximized when it is part of an integrated patient care process and integrates with other health care management tools, such as drug utilization review and medical treatment guidelines. The overall formulary system encourages physicians, pharmacists, and other care givers to work together to ensure positive outcomes and cost-effective results.

(See AMCP Where We Stand Position Statement – Formularies, and AMCP Concepts in Managed Care Pharmacy – Formulary Management)

Pharmacist's Role in Formulary Management

Policy 9922

11/01/1999 Introduced

03/01/2004 Revised

12/01/2008 Revised

10/01/2010 Reapproved

04/12/2021 Revised

AMCP supports the use of an appropriately designed formulary as a quality-enhancing, cost-effective pharmaceutical care tool that meets the needs of the patient population and assist members of the health care team in effectively managing a patient's total medical care regimen. AMCP further recognizes that pharmacists are key to the success of formulary management. Pharmacists determine the P&T Committee agenda; analyze and disseminate scientific, clinical, and health economic information for P&T Committee member review; follow-up with research when necessary; and communicate P&T Committee decisions to health plan prescribers, other health care professionals, and patients.

(See AMCP Concepts in Managed Care Pharmacy – Formulary Management and AMCP Where We Stand Position Statement – Formularies).

Development of Quality Performance Measures

Policy 0006

02/01/2000 Introduced
02/01/2005 Revised
11/01/2009 Revised
02/21/2018 Revised
02/08/2023 Revised

Patient Adherence and Persistence

Policy 0115

11/01/2001 Introduced
02/01/2006 Revised
12/01/2010 Revised

04/07/2015 Revised

AMCP supports the role of utilization management in the provision of quality, cost-effective prescription drug benefits. The fundamental goal of utilization management is to promote the appropriate and cost-effective use of medications and optimize patient outcomes. Pharmacists in all practice settings must work collaboratively to develop specific policies and procedures to ensure that the utilization management process is administered in the most efficient manner possible, is fully compliant with statutory and regulatory requirements and provides members, pharmacists and prescribers with an evidence-based, rational process to promote appropriate drug use. Examples of utilization management strategies used within a prescription drug benefit include, but not limited to, prior authorization, step therapy, quantity management, drug utilization review (DUR), channel management strategies, and the application of a formulary management system

(See AMCP Concepts in Managed Care Pharmacy – Prior Authorization).

Co-payment Offset Programs

Policy 1302

02/01/2013 Introduced

AMCP is supportive of programs that help patients afford their prescription drugs. However, some programs can needlessly encourage the use of more expensive brand-name products over their generic counterparts. They can also undermine the formulary development process by encouraging the use of products that have lower cost therapeutic alternatives. Patient safety can also be threatened when prescriptions are frequently transferred between retail pharmacies. Therefore, AMCP is opposed to manufacturer coupon programs that are promotional in nature and are not means-tested.

(See AMCP Where We Stand Position Statement – Co-Payment Offset Program)