An investigation into drug formulary priority-setting within regional health authorities in British Columbia

Growing pharmaceutical demands in communities and institutions challenge healthcare organizations to provide high quality drug therapy within a sustainable budget. Pharmacy and therapeutics (P&T) committees are typically charged with setting priorities through compiling lists of drugs for funding, yet how this transpires within regional health authorities is unclear. This study examined the practices of two regional health authority P&T committees in British Columbia in order to construct a conceptual model of drug formulary priority-setting which situates the influence of scientific evidence amongst other decision-making factors. A grounded theory approach was employed. Data sources spanned committee documents, meeting observations (n=4), and semi-structured interviews with committee members (n=15). Standard grounded theory methods for data analysis were employed, including coding using the constant comparative technique and composing analytic memos. Regional P&T committees engaged in two activities related to drug formulary prioritysetting: developing auto-substitution policies and reviewing drug addition requests. The emergent conceptual model encompassed four processes in which committees engaged for the purposes of reaching formulary decisions: i) Negotiating the margins of therapeutic advantage; ii) Seeking value for the resources allocated; iii) Interfacing between community and institutional settings; and iv) Situating decisions within an organizational context. This model was set against a background of contextual themes including the ways in which committee members balanced their P&T and patient care responsibilities, intra-committee dynamics between pharmacists and other clinical representatives, the defensive stance taken to restrict pharmaceutical industry involvement, and the ways in which decisions made by other stakeholders and decision-making bodies were incorporated into priority-setting. Study findings raise policy implications for how to assist institutions with systematically integrating real-world considerations into drug formulary priority-setting and improving the fairness of agenda-setting practices. Methodological and substantive ideas for future research are also advanced.Medicine, Faculty ofPopulation and Public Health (SPPH), School ofGraduat