Formulary management is based on the lowest net cost and considers drugs that are losing patent by category. Drugs are not considered in a silo, rather they are considered as the place in therapy within appropriate categories.
When evaluating new drugs, PharmPix P&T Committee also considers, whenever available, the concepts of:
- Relative Risk Reduction (RRR) vs. Absolute Risk Reductions (ARR): these concepts are important to understand when evaluating drugs, since depending on the one you use, the drug can be seen as more powerful or efficacious than it really is.
- Example: In a placebo controlled, 3-years clinical trial, in the group using Drug A, there was 1 heart attack in a sample size of 100, however there were 2 cases of major bleedings that needed discontinuation of the drug vs. in the placebo group there were 2 heart attacks in a sample size of 100 without major bleeding events.
- Applying the concept of RRR gives it a risk reduction of 50%
- Using the concept of ARR gives it a risk reduction of just 1%
- Number Needed to Treat (NNT): this concept helps to assess the efficacy of drugs in the real perspective. In the same trial as above, the NNT for Drug A is equal to 100, which means that you have to treat 100 members for 3 years with Drug A to prevent 1 heart attack event.
- Number Needed to Harm (NNH) is the same concept as NNT but related to a given side effect. In the same trial as above, NNH is equal to 50, which means that while treating 50 members with Drug A you most probably encounter 1 major bleeding.
Therefore, when evaluating the drug against all of this information and/or available concepts, the P&T Committee will have a clearer picture and can make a more informed decision.