1. Pharmacy & Therapeutics Committee
Presentation Developed for the Academy of Managed Care Pharmacy
Updated: February 2015

2. Objectives
Identify the purpose and structure of a Pharmacy & Therapeutics (P&T) Committee
Understand the roles and responsibilities of a P&T Committee

3. P&T Committee Purpose
Promote safe, effective, and cost-effective drug therapy
Develop policies regarding drug evaluation, selection, and utilization
Educate practitioners on drugs and appropriate drug utilization

4. Who Uses P&T?
Any organization that maintains a drug formulary utilizes a P&T Committee
Hospitals
Health Plans
Prescription Benefit Managers (PBMs)
VA and Military
Any organization that maintains a drug formulary utilizes a P&T Committee
Hospitals
Health Plans
Prescription Benefit Managers (PBMs)
VA and Military
Formulary’s Placement in the Healthcare System
As managed care expanded, formularies became more complex and more prevalent
Pharmacy and Therapeutic’s (P&T) Committees help evaluate the contents of each Formulary to ensure its contents are clinically sound
Formularies continue to be a method to control escalating drug costs
Discounts (i.e. rebates) offered by manufacturers for formulary positioning of their products allow for savings

5. P&T Committee Membership
Primarily physicians and pharmacists
Includes practitioners from a variety of specialties
May also include members from other divisions of healthcare
Nursing, Nutritional Services, Administration, Law, Quality Assurance
May also include lay member(s)
Represents plan members
Not a healthcare provider
The size of the committee can vary depending on the needs of the committee
Committee’s are typically composed of physicians and pharmacists. Additionally Nurses, Administration, Law, or Quality Assurance may be added to the committee. Organization utilize the P&T Committee to decrease the amount of bias and ensure that the formulary is clinically sound
P&T Committee’s meet regularly with most organizations meeting quarterly.

6. P&T Committee Actions Regular meetings – no less than once per quarter
CMS regulates P&T Committees for Part D plans must meet at least quarterly
Review of scientific evidence and standards of practice, peer reviewed medical literature, clinical practice guidelines, and pharmacoeconomic studies
Manage the development and maintenance of the organization’s drug formulary
CMS guidance for P&T Committees development and review of Part D formularies can be found in the CMS Medicare Prescription Drug Benefit Manual, Chapter 6, Section (

7. P&T Committee Actions
Manage educational programs regarding drug utilization
Develop policies to ensure safe and effective drug use
Develop policies to promote cost-effective drug therapy
Advise on drug distribution and control procedures

8. Factors Considered by P&T Committee
Clinical efficacy
Safety
Therapeutic need
Clinical guidelines
Standards of medical practice
Other treatment options
Pharmacoeconomics
Cost
There is a heavy weighting on safety and efficacy and therapeutic need (i.e. is there an unmet need in the class?) Cost is looked at last. All things being equal, net cost (after rebates) is the determinant. Pharmacoeconomic models are considered as they help estimate total cost of the drug in addition to the unit cost.

9. Clinical Evidence & Cost-Effectiveness
Organizations choose whether to include cost data as part of the P&T Committee Review process
If cost data is not included, drugs are reviewed solely on clinical efficacy and safety
An administrative committee is then tasked with final formulary placement decisions based on:
P&T Committee’s clinical evaluation
Cost-effectiveness data
Administrative committees often receive a clinical ranking of the drug’s clinical effectiveness in comparison with other medications in the class or therapeutic category. Administrative committees will review pharmacoeconomic data, pricing models, and manufacturer contracts along with the P&T Committees clinical evaluation and recommendation to determine formulary placement.

10. References
Navarro, R Managed Care Pharmacy Practice. 2nd edition. Sudbury, MA: Jones and Bartlett Publishers.
ASHP statement on the pharmacy and therapeutics committee and the formulary system. Am J Health-Syst Pharm. 2008; 65:2384–6.
CMS Medicare Prescription Drug Benefit Manual. CMS Website. Accessed 31 Dec 2013.

11. Thank you AMCP member Carly Rodriguez for updating this presentation for 2015.