How to use structured decision making in developing therapeutic, cost-effective formulary systems.

The formulary decision-making process must evolve from a system which places a greater emphasis on the financial factors to one which includes therapeutic and patient outcomes. Ideally, all available options and possible consequences of a decision--economic as well as clinical--should be examined by P & T Committees. In this article, three methods to assist in formulary selection and management activities are described: the inventory management approach, the cost accounting approach, and the criteria-based protocol approach. All three methods have a place in the overall development and management of an effective therapeutic formulary system.