P&T Committee
A Pharmacy and Therapeutics, or P&T, committee is an advisory group of healthcare professionals within healthcare organizations such as hospitals, health systems, or managed care plans. The committee is responsible for evaluating and managing the use of medications by ensuring that patients receive safe, effective, and cost-efficient drug therapies.1 A P&T committee consists of physicians from different specialties, pharmacists, nurses, and administrators within the institution. Some committees may include health economists, quality improvement personnel, and patient advocates or representatives. Including a broad range of stakeholders aims to ensure that drug evaluations consider clinical efficacy, safety, patient access, and financial implications for both the patient and the institution. Overall, P&T committees play a critical role in determining which drugs are included in an institution’s formulary while upholding cost-saving initiatives.
One of the committee’s key responsibilities is medication evaluation and formulary management.2 When a new medication becomes available or is requested for addition to the formulary, the committee conducts a thorough review of clinical trial data, real-world evidence, safety profiles, therapeutic alternatives, and cost-effectiveness. The pharmacy department prepares a monograph for each medication in the analysis to review and analyze data, including pharmacokinetics, efficacy, safety, risk evaluation and mitigation strategies, and cost. Based on this analysis, the committee decides whether to approve, restrict, or deny the medication for use within the system. Similarly, the committee can remove a medication from a formulary if it deems a loss of safety, ineffectiveness, lack of evidence, or if it adheres to changes in clinical guidelines.
A key second responsibility of the committee is establishing institutional guidelines and protocols to guide medication use.3 In other words, the committee develops and updates healthcare organization guidelines, academic institution or hospital guidelines, and insurance guidelines with the goal of appropriate and safe medication use throughout the organization. For example, it might recommend specific drugs as first-line therapies for certain conditions or create step therapy requirements that encourage the use of lower-cost alternatives before higher-cost medications are approved. These decisions help standardize care, improve outcomes, and control healthcare costs.
In addition to reactive decisions about new drugs, the P&T committee often conducts ongoing therapeutic class reviews.4 These reviews assess entire categories of medications, such as biologics, to identify opportunities for formulary optimization. This may involve removing redundant or less effective products, adjusting formulary tiers, or negotiating better pricing from manufacturers.
In the hospital and health system setting, the P&T committee ensures that medications are used appropriately and in compliance with clinical best practices and regulatory standards. It also monitors for adverse drug events, medication errors, and drug shortages and develops policies to mitigate these risks. By promoting evidence-based medication use, the committee supports both inpatient safety and operational efficiency. In managed care and insurance organizations, the P&T committee plays a similar but broader role. The committee's decisions impact drug coverage policies for large populations. They evaluate drugs for inclusion on commercial or Medicare formularies and may set prior authorization requirements or tier placement within a formulary. These decisions directly influence which medications are accessible to patients and at what cost. The Academy of Managed Care Pharmacy, or AMCP, is a great resource to gain extensive knowledge on P&T committees as well as managed care and insurance organizations. One helpful AMCP resource to begin further research is its discussion on Formulary Management.
The committee usually meets on a regular basis (monthly, quarterly, or as needed) to evaluate new drugs, review formulary performance, and address any emergent issues. Drug manufacturers may submit dossiers, such as AMCP Format dossiers, to support formulary consideration. It is important to note that the committee remains independent and bases its decisions on unbiased evidence and internal standards. While maintaining an unbiased viewpoint, the committee must also maintain trust and reliability between itself and its institution. Transparency, integrity, and conflict of interest management are crucial to maintain credibility of a P&T committee. Members are usually required to disclose any financial relationships with potential conflicts, such as pharmaceutical companies. The disclosures help establish that committee decisions are based on the best interests of patients and the healthcare system rather than outside influences.
Transparency, integrity, and conflict of interest management are crucial to maintain credibility of a P&T committee!
Ultimately, the P&T committee serves as a critical gatekeeper in the healthcare system, helping to optimize innovation, safety, cost, and access. Through careful analysis and policy development, the committee guides the rational use of medications to ensure that patients benefit from scientifically validated and economically sustainable drug therapies. The committee is a vital healthcare body that plays a key role in establishing the safe, effective, and cost-efficient use of medications while aiming to improve patient care and enhance healthcare outcomes.
References:
1. Cleveland Clinic. Keys to Developing a System-Wide Pharmacy and Therapeutics Committee. Consult QD. 2019.
2. Ciccarello C, Leber MB, Leonard MC, Nesbit T, Petrovskis MG, Pherson E, et al. ASHP Guidelines on the Pharmacy and Therapeutics Committee and the Formulary System. Am J Health-Syst Pharm. 2021; 78:907-918.
3. Rowell J, Hannum C. Ask the Pharmacist: the Role of a Pharmacy and Therapeutics (P&T) Committee. Enlyte. 2024.
4. Persson EL, Miller KS, Nieman JA, Sgourakis AP, Akkerman SR. Formulary Evaluation Using a Class Review Approach: Experience and Results From an Academic Medical Center. P&T A Peer Reviewed Journal for Formulary Management. 2013;38(4):213-216.