Management Q&A: The Health-System Pharmacy and Therapeutics Committee

Q: How can a multisite health system create a system pharmacy and therapeutics committee (P & T) that is meaningful for its acute care hospitals and infusion centers?

A: Many health systems are implementing a standardized medical record and, therefore, need to build and maintain 1 formulary. One strategy is to choose an existing formulary from 1 site and copy it to all other sites. Baptist Memorial Healthcare Corporation (BMHCC) comprises 14 hospitals and 19 infusion centers in 3 states. With more than 2000 inpatient beds, BMHCC needed a mechanism to ensure that all patients had access to necessary medications and that evidence-based, cost-effective decisions were being made across the system.

Developing a Committee Structure

Under the BMHCC structure, it was decided that a physician champion, such as the system chief medical officer (CMO), is an appropriate committee chair. A pharmacy leader, such as a system pharmacy administrator, facilitates the agenda and works to attain pre-meeting consensus. Each entity is represented by a physician voting member and a pharmacy voting member. The voting members are mostly the CMOs, P & T chairs, and pharmacy leaders from each hospital.

Preparation for the initial system P & T Committee meeting included:

• Approval by entity senior leaders, CEOs, and pharmacy leaders of a committee charter regarding scope, quorum, voting membership, attendance, and participation requirements
• Collaboration of system and entity pharmacy leaders
• Provision of an agenda and supportive information to committee members (physician and pharmacy) for entity site discussion

Establishing a Sustainable Model

A sustainable model is established by:

• Collaborating with system and entity physician and pharmacy leaders as subsequent agendas are prepared
• Having conference calls with relevant decision makers several weeks before each system P & T meeting; a proposed list of agenda items is discussed and finalized for the upcoming meeting
• The cancer center developing a medication management committee to discuss oncology-specific medications and send a recommendation to the system P & T
• Providing a final agenda, with supportive information, to the full committee 2 weeks before the system P & T meeting
• Engaging physician and pharmacy leaders with peers to bring the entity’s vote

Executing the Deliverables

The following are used to execute the model:

• System P & T is facilitated, via consent agenda, using topic discussion and voting

• Member attendance via phone or Web conference, or in-person appearance, when appropriate

• System P & T minutes are provided to relevant entity medical staff leadership committees for final approval (Figure)

• Formulary changes are then made in the electronic medical record

Addressing the Challenges

Ideally, pharmacy leaders would discuss agenda items and have time to take them to their entity P & T for approval before the system P & T meets. When that does not occur, we are able to use other entity committees to ensure items are fully vetted before bringing them to the system P & T. Whether recommendations come to or from the system P & T, the entity medical staff always has final approval of recommendations (Figure). BMHCC has completed 12 system P & T meetings and plans to continue this structure for system formulary maintenance.

Jillian Foster, PharmD, MBA, is system pharmacy service line administrator at Baptist Memorial Healthcare Corporation in Memphis, Tennessee.