What Is a Hospice PBM Formulary?

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The hospice receives a list of medications covered by the PBM, known as a PBM formulary, which is then distributed to the hospice personnel. Hospices can significantly reduce their pharmaceutical spending by strictly adhering to the formulary.

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Who is the target audience?

Everyone involved in the patient’s care, from doctors to nurses to pharmacists, consults the formulary for guidance on treating the patient’s unique set of symptoms and underlying medical conditions best. A well-written, well-executed formulary has other benefits, including reducing pharmaceutical costs and improving drug management for all hospice patients.

Hospice medical directors (HMDs) and clinical pharmacists can collaborate with PBMs to create a tailored formulary that supports evidence-based and individualized prescribing. This is especially significant for hospice-focused PBMs. The technique needs to be updated regularly to account for new medical discoveries and recommendations and the ever-changing cost of medications. The interactions, hazards, and benefits of each medication and their effectiveness as an antidote at the end of life must be carefully considered.

It’s important to note that there are two distinct varieties of formularies.

There are two formularies: open (which allows patients to receive medications not on the formulary) and closed (drugs not listed on the formulary must require an override for approval). Every single off-formulary medication, whether open or not, must be checked by the HMD and the pharmacist. It is crucial to assess the medical necessity of medications that are not immediately helpful in symptom palliation. As well as any changes in prescribing patterns. The use of specific drugs that may not be effective or acceptable for the hospice patient. Brand versus generic utilization, and so on.

After careful consideration, it should be decided whether or not the formulary has to be updated to account for non-formulary use. Concerns about risk vs. benefit, appropriateness, and pill burden, as well as more cost-effective alternatives to current medications, will help direct the hospice team’s clinical education needs.

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