As a result of the rapid innovations in drug technology, and the increasing complexities surrounding drugs' safety, cost, and efficacy, the demand for extensive formulary reviews is growing. To keep pace, Pharmacy & Therapeutics (P&T) committees have been ardently reviewing medications to determine which ones deserve inclusion and preferred placements in health plans and formularies. While there are many factors that influence the committees' decisions, with some carrying more weight than others, pharmaceutical execs complain that there is no accurate way to predict which drugs will make the cut.
But there are certain measures pharmaceutical companies can take to better position their products. A handful of P&T committee members, who spoke at Pharmaceutical Executive's Marketing Summit last April, offered insight into their decision-making processes.
The Cost vs. Quality Question
The P&T review process is multi-faceted, and while there's an obvious focus on ensuring a drug's clinical safety and efficacy, there is also the question of cost efficiency. "Years ago, the decision was purely based upon cost and they didn't really look at non-clinical, non-value driven issues," says Fredrick Bender, director of pharmacy, Greenville Memorial Hospital. Now, he says, the committee's focus has shifted. "The P&T committee is looking a lot more at outcomes and quality of care. It's a much more objective and value-driven process." While cost is still a factor in the mix, he says, "it's third or fourth on the list in terms of important criteria to look at."
Steven Arnold [far left] and Cynthia Pigg discuss how to get a drug onto the committee's radar screen, at Pharmaceutical Executive's annual Marketing Summit, held last April.
But the mere task of assessing a drug's value can be a challenge in itself. Many committee members agree that it's important to differentiate what is the marketing and sales pitch from what the clinical evidence says about the quality of the product. The challenge often becomes figuring out what's fact and what's perception.
Looking at a drug's comparative value is key, says Cynthia Pigg, the newly appointed executive director for the Foundation for Managed Care Pharmacy and former vice president of pharmacy, Cigna Healthcare. "We are looking for drugs that actually are going to treat the given condition better, not ones that are just clinically neutral," she says. Ninety percent of the drugs she sees fall into the clinically neutral category, she says.
Often, the committee will take a look at the drug's market position. "Sometimes, we will prefer to have a market leader. In that case, if the price is competitive, we'll pay a bit more for it," she says. If a drug proves to be superior, she says, cost is not a component. "Cost is a factor in the value equation, quality is a factor in the value equation," she says. "But as our process will show, and if I may steal an old phrase from Ford, quality is definitely job one."