Use of an Innovative Pharmaceutical Class Scoring Tool for Prioritized Annual Formulary Review

  • Holly Sheldon Froedtert & the Medical College of Wisconsin
  • Audrey Kostrzewa Froedtert & the Medical College of Wisconsin; Concordia University Wisconsin
  • Shannon Werner Froedtert & the Medical College of Wisconsin
  • Terry Audley Froedtert Menomonee Falls Hospital
  • Adam Biggs Froedtert & the Medical College of Wisconsin
  • Taylor Mancuso Froedtert & the Medical College of Wisconsin
  • Mary Frances Picone Froedtert & the Medical College of Wisconsin; National Institutes of Health, Clinical Center Department of Pharmacy
Keywords: Hospital formulary; formulary committee; drug information services; drug class review


Background: Though The Joint Commission requires health systems perform annual formulary review, guidance for how to perform this review is lacking. Published methods include comprehensive review of all pharmaceutical classes; however, this approach may not be the most efficient or effective option for a health system with a large formulary.

Objective: To create a prioritization system for annual formulary review through development of a pharmaceutical class scoring tool.

Methods: Drug information pharmacists developed the scoring tool, which used external and internal data to score pharmaceutical classes in 4 categories: safety, efficacy, cost, and utilization. The primary outcome, number of formulary changes resulting from pharmaceutical class review, was compared between the highest-scoring and lowest-scoring class to assess the tool’s ability to prioritize high-yield class reviews.

Results: The tool calculated scores for 91 pharmaceutical classes, altogether containing 962 medications. After review of the highest-scoring class, corticosteroids, 2 formulary changes were made: one dosage form was removed from formulary, and one medication was restricted to outpatient use only. Zero formulary changes resulted from review of the lowest-scoring class, pharmaceutical adjuvants.

Conclusions: The tool described in this study prioritized annual formulary review efforts by identifying a pharmaceutical class with meaningful formulary optimization opportunities as the highest-scoring class, while correctly identifying a class with no optimization opportunities as the lowest-scoring class.


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Received 2022-03-28
Accepted 2022-06-13
Published 2022-06-15
Formulary Evaluations