eDossiers Part of the Evolution Demanding Evidence-Based P&T

San Francisco—Pharmacy and Therapeutics (P&T) committees have evolved considerably with the demand for evidence-based decisions, according to information presented by Chryss MacGowan, RPh, director, pharmacy services managed care, Denver Health Medical Plan, Inc., and Kelly Chillingworth, RPh, MHA/Ed, CGP, director, bundled services, DaVita Rx.

In a Contemporary Issues session at the AMCP meeting titled Evolution of P&T Committees: Navigating New Advancements and Technologies, the speakers provided an overview of the AMCP eDossier System.

In the past, the drug mix consisted mainly of oral therapies, a few generics, “me too” drugs, inhalers, and nebulizer solutions. Committees were composed mainly of a few specialties and 1 or 2 pharmacists. Benefit types included commercial plans, staff model HMOs, and state programs. Committees used monographs, available studies, and a variety of manufacturer-provided information to make decisions.

Today the scenario is much more complex. The drug mix now includes many important generics, specialty self-injectables for chronic diseases, and oral chemotherapy. Benefit types include commercial plans, managed Medicaid, Medicare Part D, and value-based benefit designs. The need for evidence-based decisions has been made clear and, therefore, today’s decision-making tools must consist of data, with class 1 studies preferred.

When submitting a dossier for formulary consideration in the past, pharmaceutical manufacturers typically disseminated them by e-mail or CDs in PDF format. This method presented some challenges because there were various methods to request information and searching for specific information was time-consuming for healthcare decision makers. A dossier could become outdated. Additionally, manufacturers may not have clearly understood the utility of dossiers.

Today, the AMCP eDossier System provides a centralized, secure, web-based platform, allowing qualified healthcare decision makers the opportunity to easily access, review, and evaluate research to make informed, evidence-based decisions. These benefits, the presenters told attendees, are numerous (Table).

In order to access the system, one must be a healthcare decision maker actively involved in making formulary and/or benefit design decisions. “However,” the presenters explained, “access to a specific dossier can only be done through an unsolicited request from the decision maker to the product manufacturer, who then decides if the decision maker is approved to access their specific product dossier.”

Ms. MacGowan and Ms. Chillingworth told the audience additional enhancements will be coming to the AMCP eDossier System later this year, including more tools that will further support review and monograph development (eMonograph builder and Therapeutic Review tools); 1-on-1 training for healthcare decision makers and a customer help desk; and iPad optimization along with an iPad app.

In concluding their discussion, the presenters noted the future for P&T committees will continue to evolve, as drug mixes expand to include oral, targeted therapies for oncology, and genomics requiring advanced prior authorization. Benefit types will encompass high deductible health plans, insurance exchanges, Medicare expansion, and universal coverage.