Clinical pharmacy criteria for medical decision-making

Clinical criteria for pharmacy reviews guide the pharmacy staff in decision-making for clinical appropriateness.

The vice president of pharmacy or designee will coordinate and prioritize drugs or drug classes that have been identified as requiring review for formulary status as follows:

• Proactive evaluation of new pharmaceuticals
• Request of credentialed practitioner/provider
• Regular review of existing pharmaceuticals

A comprehensive review of the identified drugs or drug classes is accomplished through clinical research, which may include but is not limited to:

• Scientific and medical literature
• State and federal regulatory agencies (e.g. Food & Drug Administration)
• Other federal agencies (e.g. National Institutes of Health, Centers for Disease Control and Prevention)
• Professional organizations (e.g. American Medical Association, specialty academies)
• Managed care industry standards
• In-house experts and standing committees
• Practitioners and providers
• Pharmaceutical industry clinical information

Pharmacy criteria for clinical decision-making are developed based on the above research and the review and approval of the Pharmacy and Therapeutics (P&T) Committee. The criteria are reviewed annually, or more frequently if needed, and approved by the P&T Committee. The committee is responsible for recommending, establishing and monitoring policies, procedures and programs that ensure rational, cost-effective drug therapy based on sound clinical evidence that meets the individual needs of all our membership.