Global Formulary Review: How Do We Integrate Pharmacogenomic Information?

OBJECTIVE: To summarize a standard formulary decision process and provide recommendations for the integration of pharmacogenomic (PGx) information within the formulary decision-making process. DATA SOURCES: With use of MEDLINE (1920-March 2010), the terms "formularies, hospital" and "pharmacogenetics" were searched in the MeSH database, yielding no results. The MeSH terms were then searched separately in addition to searching for "rational drug therapy" and "essential medicines list" through the main PubMed database. STUDY SELECTION AND DATA EXTRACTION: Articles deemed relevant to both terms were assessed, interpreted, and incorporated as key pieces to the review of formularies and the integration of PGx information as a part of the formulary review process. The articles referenced were deemed appropriate and categorized into 5 areas: formulary management systems and pharmacy and therapeutics (P&T) committees, international formularies, formulary decision-making, PGx evidence, and recommendations regarding integrating PGx into formulary decision-making. DATA SYNTHESIS: The field of PGx is rapidly evolving as the evidence supporting genetically guided individualized therapy continues to grow. To bring this evidence from the bench to the bedside, institutions will need to evaluate PGx data to integrate individualized therapy into practice. Few standardized methods exist to analyze and apply clinical PGx data and incorporate the information into drug evaluation at the formulary level. Several online sites provide resources to aid in formulary review and can be used when incorporating clinically relevant PGx information into a formulary decision. In addition, there are key questions that organizations can ask as they evaluate the PGx information in each step of the decision-making process. CONCLUSIONS: P&T committees should formulate a plan to integrate a search for pharmacogenomic data with each drug evaluation and integrate the results into the formulary decision process to enhance the appraisal of drug efficacy, safety, and cost.