New Tool Helps Decide Best Drugs to Place on Formulary Lists

A new tool to guide decisions about safe and effective medication use has been developed at the University of Illinois at Chicago College of Pharmacy.

Drug formularies are used by hospitals, health systems and private and government insurance plans to specify which medicines are approved or preferred for use within that system. Formularies are compiled based on the efficacy, safety and cost-effectiveness of drugs.

Bruce Lambert, director of UIC’s Center for Education and Research on Therapeutics, headed a team that devised a checklist of six overarching questions that provides a framework for formulary decision-making.

The new tool, tested at two teaching hospitals — the University of Illinois Hospital and the John H. Stroger, Jr. Hospital of Cook County — is designed to assist formulary committees in evaluating drugs being considered for inclusion. If the drug is to be added to the formulary, the tool helps determine what restrictions, if any, should be placed on the drug.

The tool poses 48 questions, grouped into six themes, related to the decision-making process and evidence of need, efficacy, safety, potential for misuse and cost.

“The questions are framed in such a way as to look for evidence of benefit and safety before placing the drugs on the formulary,” Lambert said. “This shifts the burden of proof onto those who would advocate placing a drug on the formulary, rather than the assumption all drugs should be included.”

Before allowing a new drug on the formulary, the new tool will encourage the formulary committee to seek out and evaluate “a great deal” of evidence, Lambert said, “because we shouldn’t be exposing patients to needless risks or promoting or paying for expensive new drugs that are poorly understood.”

The work originated from the Formulary Leveraged Improved Prescribing (FLIP) project, funded by the U.S. Attorney General’s Consumer and Prescriber Education Grant Program and supported by the Agency for Healthcare Research and Quality (AHRQ). Lambert’s collaborators were Bill Galanter, Jay Duhig, Michael Koronkowski, Amy Lodolce, Pam Pontikes, John Busker, Dan Touchette and Surrey Walton of UIC; and Gordon Schiff of Harvard Medical School.

UIC ranks among the nation’s leading research universities and is Chicago’s largest university with 27,500 students, 12,000 faculty and staff, 15 colleges and the state’s major public medical center. A hallmark of the campus is the Great Cities Commitment, through which UIC faculty, students and staff engage with community, corporate, foundation and government partners in hundreds of programs to improve the quality of life in metropolitan areas around the world.