Creation and application of a value-based framework for formulary management

PURPOSE: A novel value assessment framework (VAF) for evaluating oncology and nononcology medications for formulary addition was developed and validated at UT Southwestern Medical Center (UTSW). METHODS: The novel VAF was developed based on literature examples while incorporating UTSW institutional priorities in the formulary decision process. Six criteria were selected to be evaluated in the VAF: efficacy, toxicities/safety, novelty/unmet need, quality of evidence, cost (by administration site), and operational logistics. The study included a retrospective review of the monographs of medications considered for formulary addition between October 2021 and October 2024, with scores evaluated for inter-rater reliability via the intraclass correlation coefficient (ICC) among 3 reviewers. Monographs for diagnostic or nontherapeutic targeted agents, drug class reviews, and otherwise incomplete monographs were excluded from the study. RESULTS: The novel UTSW VAF was determined to have good inter-rater reliability overall among the 3 reviewers (ICC, 0.75; 95% confidence interval [CI], 0.61-0.85). For oncology medications, the VAF had moderate inter-rater reliability (ICC, 0.63; 95% CI, 0.29-0.82). The UTSW VAF showed excellent overall inter-rater reliability for nononcology medications (ICC, 0.80; 95% CI, 0.62-0.90), with each individual criterion also showing moderate to excellent reliability, among 3 reviewers. CONCLUSION: This study showcases the development and retrospective evaluation of the inter-rater reliability of a novel institution-specific VAF for medication formulary review at UTSW. The VAF was determined to have good inter-rater reliability overall, with moderate, good, or excellent reliability across all categories. Most monographs scored in the low-intermediate to high-intermediate scoring range, with 3 monographs scoring in the high category.