Formulary Decisions to Administrators??!!

Discussion in 'Pharmacy' started by RosemontPharm, Sep 25, 2014.

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  1. RosemontPharm

    RosemontPharm 2+ Year Member

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  3. 297point1

    297point1 1,000+ Post Club 7+ Year Member

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    Interesting read, but nothing particularly newsworthy. This has been in the works for a while now- just look at the drop in sales reps (down almost 40% in the last decade) cited in the article.

    Also: Electa Stern is a PharmD. Google is your friend.
     
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  4. Sparda29

    Sparda29 En Taro Adun Gold Donor 7+ Year Member

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    IMO, physicians should not have a say in the formulary process either.

    Drug reps are pretty much banned at every hospital I work at or have worked at.
     
  5. PumpkinSmasher

    PumpkinSmasher Pharmacist 7+ Year Member

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    Physician input in the formulary process is valuable and necessary. Would love to hear your reasoning...
     
  6. Sparda29

    Sparda29 En Taro Adun Gold Donor 7+ Year Member

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    I'm just biased because I've seen some absurd requests. One guy wanted Televancin on the formulary, another guy wanted Famvir on the formulary, another doc wanted once daily Amoxicillin formulation too.
     
  7. Praziquantel86

    Praziquantel86 Moderator Emeritus 7+ Year Member

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    What is so absurd about any of those requests? Especially telavancin and famciclovir?
     
  8. Sparda29

    Sparda29 En Taro Adun Gold Donor 7+ Year Member

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    If they wanna order them and go through the process to order a non-formulary medication after presenting the case to the chief of medicine and the director of pharmacy, then sure it's ok.

    These guys wanted these medications to be in stock at all times and to be able to order them without approval from the chief of medicine and director of pharmacy as if they were cheap like ciprofloxacin and metronidazole.
     
  9. 297point1

    297point1 1,000+ Post Club 7+ Year Member

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    Isn't famciclovir available as a generic?
    (not that it guarantees cheap pricing if a manufacturer like Mylan has cornered the market).
     
  10. KidPharmD

    KidPharmD Pediatric Pharmacist 2+ Year Member

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    Except that is why we have P&T in the first place. If the process works, then you don't have to worry about medications that shouldn't be approved being approved. I assume that these two requests were denied? If so, that means that your P&T functions properly. The approval process works best as a joint venture between physicians, pharmacists, and others.

    I still don't see the problem with the requests. The two physicians wanted to use these meds more freely, so they asked. As I assume, P&T said no, then life goes on. We also have silly requests go through P&T sometimes. IV Acetaminophen goes up about once every 9-10 months or so. We approved it the first time, and the use was totally inappropriate. So far, no one has been able to justify its addition, and it hasn't been re-approved.
     
  11. msweph

    msweph 2+ Year Member

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    We use a **** ton of IV Tylenol
     
  12. Sparda29

    Sparda29 En Taro Adun Gold Donor 7+ Year Member

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    Yeah, for us it can only be ordered by anesthesia for 3 doses max.
     
  13. msweph

    msweph 2+ Year Member

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    I think our max is 24 hours. But they can reorder. No one will touch the order bc anesthesia ordered it so you have to call them to get it discontinued
     
  14. RosemontPharm

    RosemontPharm 2+ Year Member

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    Do you guys think pharmacists can play the role of the rep working for the pharmaceutical company? Perhaps the pharmacist would have credibility when discussing with the administrators at the hospitals....
     
  15. KidPharmD

    KidPharmD Pediatric Pharmacist 2+ Year Member

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    Many of the Medical Science Liaisons (think smarter drug rep) are pharmacists. The problem is that many hospitals are banning drug reps without a specific invitation from the hospital or staff. Makes for less need for these positions.
     
  16. confettiflyer

    confettiflyer Did you just say something? 10+ Year Member

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    I'm pretty liberal when it comes to IV APAP...if we can curtail opioid use then we can theoretically contain additional costs associated with snowing out a few patients.
     
  17. msweph

    msweph 2+ Year Member

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    I'm fine with it as well. Just when someone is taking PO I think they should convert to PO APAP
     
  18. Praziquantel86

    Praziquantel86 Moderator Emeritus 7+ Year Member

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    So
    As another poster mentioned, the purpose of P&T is to review requests in light of available evidence and the needs of the institution. There is nothing wrong with submitting a request for a formal review to P&T. Also, adding a drug to formulary doesn't necessarily preclude restrictions on its use to certain indications or prescribers - in fact, I'd say that this is common, especially for antimicrobials.

    I'd also argue that the high cost in and of itself shouldn't be your sole determinant for deciding a drugs place on your formulary. Besides cost, are there any other reasons that you think the three drugs you mentioned are not appropriate for formulary status (let's say, for arguments sake, that they would be on Sparda formulary where no restrictions are possible at all once its approved)?
     
  19. confettiflyer

    confettiflyer Did you just say something? 10+ Year Member

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    Depends...ability to take PO in the immediate post-op period isn't a deal killer in terms of IV APAP. That said, we hard limit to 24hrs and have a chat with a prescriber if they want to continue, mostly for the reasons stated above regarding difficulty reaching an anesthesiologist who did the initial order.
     
  20. confettiflyer

    confettiflyer Did you just say something? 10+ Year Member

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    I think if Sparda ran a hospital, the only things on formulary would be dilaudid, marijuana, and keflex.

    And hookah...maybe hookah.

    :=|:-):
     
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  21. Sparda29

    Sparda29 En Taro Adun Gold Donor 7+ Year Member

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    Smoke 1 joint QID. For real though, I wonder if they would be able to make a nebulized form of THC.
     

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