Background: There is a worldwide pressure to contain costs and provide value-for-money in healthcare. When introducing a new drug to the hospital, Pharmacy and Therapeutic (P&T) committee is expected to apply the principles of evidence-based medicine to meet the need of a limited number of drugs in the formulary. There is interest in how decisions are made under the global budget policy in Taiwan.

Objectives: The decision making process of accepting a new drug in the P&T committee was introduced.

Methods: Before the meeting a list of evidence documents were prepared by the formulary pharmacists, including clinical trial data, bioequivalence data, cost, existing drugs, original or generic drugs, decisions of P&Ts in other hospitals, and personality of the applicant. The formulary pharmacists also prepared documents comparing the new drug and formulary drugs. Information listed in the table compared the same class drug in the formulary according to MICROMEDEX(R) and AHFS Drug Information. Three initial reviewers had to describe the reasons whether agree or disagree to use the drug in the evaluation form. During the meeting, the applicant physicians had to explain the reasons of application. When physicians finished the presentation, the P&T committee members then vote for the final decision.

Results: Scientific evidence and cost were usually the main issues during the discussion. Due to limited number of items in the formulary, the committee usually requested the applicant to delete a drug with similar pharmacological effect out of the formulary when a new drug is accepted, unless strong evidence showed its clinical effect unable to be replaced.

Conclusions: Cost plays an important role in the reviewing process. Under the hospital global budget policy, the reasonable price discount of generic drugs was found to be the most important factor to be accepted the formulary. Reasons will be described in more detail later.