Formulary and P&T Strategy

Formulary and P&T committee strategy for health systems

Formulary process design, P&T committee structure, and evidence review for health-system pharmacy leaders. Built around what a P&T committee actually asks, and what it needs in front of it before a drug moves.

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What this covers

This work is process and evidence design. It is product-neutral and does not advocate for any specific therapy.

Formulary process design

A defensible process that produces decisions on a schedule instead of decisions under pressure.

Formulary request intake and triage standards
Class review calendar and prioritization
Restriction, criteria-for-use, and monitoring design
Non-formulary and exception handling

P&T committee structure

Composition, cadence, and evidence standards that make the committee a decision body, not a review body.

Committee charter, membership, and subcommittee design
Agenda discipline and pre-read standards
Conflict of interest process
Decision documentation and communication to the field

Evidence and dossier review

What holds up in front of a pharmacy and therapeutics committee, and what gets sent back.

Evidence package and dossier review against committee standards
Comparative effectiveness and place-in-therapy framing
Budget impact and total cost of care modeling inputs
Real-world evidence expectations and limitations

Biosimilar and interchange strategy

The operational half of the decision: what changes in the order set, the pump, and the bill.

Biosimilar evaluation and conversion sequencing
Therapeutic interchange policy and approval path
Payer coverage alignment and reimbursement impact
Operational conversion planning and staff communication

Oncology pathway alignment

Where formulary decisions and oncology pathways disagree, and how to close the gap.

Pathway and regimen library alignment with formulary
Order set and build implications
Clinical, pharmacy, and finance alignment on new regimens
Post-decision utilization review

Drug spend governance

Connecting formulary decisions to the number finance is watching.

High-cost drug review and approval thresholds
Drug spend forecasting inputs and variance review
Site of care and benefit routing implications
Executive and board reporting structure

What you get

Deliverables are short by design. The test is whether your team can run them after I leave.

Deliverables

A formulary and P&T process map with the decision points and owners named
Committee charter, evidence standards, and pre-read template
A class review calendar you can hold to
A written evaluation framework that new requests are scored against

When people call

P&T meetings run long and decisions still get deferred
High-cost drug requests are arriving faster than the process can absorb them
Biosimilar conversion stalled between clinical agreement and operational change
Formulary decisions and oncology pathways have drifted apart
Finance and pharmacy disagree on what a new agent will actually cost

Start with a 30-minute call

Bring the audit finding, the number that is not adding up, or the workflow that keeps stalling. If I can help I will tell you how. If I cannot, I will point you to someone who can.

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