Clinical Philosophy

Second Line of Defense

Formulary Management

We look for simple ways to manage formularies based on the lowest net cost and consider drugs that are losing patents.

Image of pharmacist in white coat working in a tablet

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.