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Drug formulary decision-making in two regional health authorities in British Columbia, Canada

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  • Armstrong, Kristy
  • Mitton, Craig
  • Carleton, Bruce
  • Shoveller, Jean

Abstract

Objectives Growing pharmaceutical demands challenge healthcare organizations to set drug funding priorities (i.e. establish a formulary list). This responsibility typically rests with pharmacy and therapeutics (P&T) committees, yet how the process transpires within regional health authorities is unclear. The purpose of this study was to construct an explanatory model of drug formulary priority-setting as it occurs within regional health authorities.Methods A grounded theory approach was employed to study the practices of two regional health authority P&T committees in British Columbia, Canada. Data sources spanned committee documents, meeting observations (n = 4), and semi-structured interviews with committee members (n = 15). Data analysis involved coding using the constant comparative technique and writing analytic memos.Results Regional P&T committees engaged in two activities related to drug formulary priority-setting: developing auto-substitution policies and reviewing drug addition requests. Four processes were central to decision-making: (i) negotiating margins of therapeutic advantage; (ii) seeking value for the resources allocated; (iii) interfacing between community and institutional settings; (iv) situating decisions within an organizational context.Conclusions Findings highlight opportunities for institutions to improve the fairness of agenda-setting practices, and for additional collaboration between policy-makers who prioritize drugs for publicly funded formularies applicable to institutional versus community settings.

Suggested Citation

  • Armstrong, Kristy & Mitton, Craig & Carleton, Bruce & Shoveller, Jean, 2008. "Drug formulary decision-making in two regional health authorities in British Columbia, Canada," Health Policy, Elsevier, vol. 88(2-3), pages 308-316, December.
    • Handle: RePEc:eee:hepoli:v:88:y:2008:i:2-3:p:308-316
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    1. Mitton, Craig & Patten, San & Waldner, Howard & Donaldson, Cam, 2003. "Priority setting in health authorities: a novel approach to a historical activity," Social Science & Medicine, Elsevier, vol. 57(9), pages 1653-1663, November.
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    6. Wirtz, Veronika & Cribb, Alan & Barber, Nick, 2005. "Reimbursement decisions in health policy--extending our understanding of the elements of decision-making," Health Policy, Elsevier, vol. 73(3), pages 330-338, September.
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    2. Branko Boskovic, David P.Byrne, Arvind Magesan, 2012. "Herding Among Bureaucrats," Department of Economics - Working Papers Series 1158, The University of Melbourne.
    3. Wranik, Wiesława Dominika & Zielińska, Dorota Anna & Gambold, Liesl & Sevgur, Serperi, 2019. "Threats to the value of Health Technology Assessment: Qualitative evidence from Canada and Poland," Health Policy, Elsevier, vol. 123(2), pages 191-202.
    4. Smith, Neale & Mitton, Craig & Hall, William & Bryan, Stirling & Donaldson, Cam & Peacock, Stuart & Gibson, Jennifer L. & Urquhart, Bonnie, 2016. "High performance in healthcare priority setting and resource allocation: A literature- and case study-based framework in the Canadian context," Social Science & Medicine, Elsevier, vol. 162(C), pages 185-192.

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