Participation and influence of individuals and committees that decide on drug availability in HMOs

The individuals and committees involved in each phase of the process for deciding which drugs to make available to HMO enrollees were identified, and level of participation and influence were studied. A questionnaire based on eight phases of the drug availability decision-making process that listed eight individuals and four committees was developed. The questionnaire was pretested and sent to 303 HMOs randomly selected from a 1993 national directory. Respondents were asked to rate on a 5-point scale the frequency of participation and the perceived influence of each person and committee at each phase. The survey response rate was 28%. Individuals and committees varied significantly within each phase of the process. Pharmacy directors, pharmacy and therapeutics (P&T) committees, formulary committees, and drug information specialists participated frequently to always in the first six phases; only pharmacy directors and P&T committees exerted a large influence to complete control during those phases. Pharmacy directors and drug information specialists participated most, compared with other individuals. Nursing directors and nurses participated least and exerted the least influence. Pharmacy directors and P&T committees participated the most and exerted the greatest influence in determining which drugs HMOs should include in their prescription benefits.