The Basics

Under this standard, the P&T committee may consider economic factors, but only after it has considered a drug's safety, efficacy, and therapeutic need.  In addition, if the FDA has approved a new drug therapy shown to be beneficial in peer-reviewed studies, and there is no equivalent drug therapy, the committee should not exclude that therapy.

Management Tips

Your organization's policy and procedure on this topic must be clear that economic considerations are secondary to a drug's clinical factors.  You will need to make sure that the policy complies with any applicable regulatory considerations.

URAC Accreditation Tips

The first element of the standard is mandatory; the second is weighted 4.

For the desktop review, submit the applicable policies and procedures that address economic formulary considerations.  URAC also recommends that you submit any documents from the regulatory compliance program that address mandatory generics.

The on-site review will focus on committee minutes in an interview of formulary staff members to assess their understanding of the requirements of the standard.