Mayo Clinic’s formulary is developed by a system-wide committee. The Mayo Clinic Pharmaceutical Formulary Committee is primarily a policy-making body, composed of all Mayo Clinic chief pharmacy officers and the chairs of all pharmacy and therapeutics (P&T) committees. The group meets approximately three to four times per year and is overseen by supply chain and finance. In addition, the committee is accountable to the dean of clinical practice and the chief pharmacy officer.

The committee makes some formulary decisions for products that are used across many specialties (for example, immune globulin), but most formulary decisions are left to 12 specialized task forces that focus on formulary decisions for different specialty areas.

Leverage specialty expertise

Each of the 12 specialty task forces meet monthly or as needed to make formulary decisions for drugs utilized by their specific clinical specialty. The task force membership is dynamic, which allows leaders to swap out clinical experts based on the expertise needed to evaluate each new set of medications.

For a binding vote, a quorum of three physicians (at least one from a non-Rochester site) and one pharmacist must be met. Any clinician with a conflict of interest, such as direct remuneration and/or research funding, does not count towards quorum. See below for a listing of the specialty task force members.

Specialty task force membership

• Chair: Physician leader in that specialty, responsible for assembling relevant stakeholders
• Vice-chair: Clinical pharmacist assigned to that specialty
• Expert clinicians: Chosen by task force chair based on expertise needed for each drug review
• Managed care pharmacist: Help create prior authorization processes, provide a different perspective during P&T deliberations (5 FTEs system-wide)
• Contract portfolio manager: Pharmacists who consult on drug pricing options and liaise with industry contacts. Need five to seven years of experience at the medical center to qualify for this position (2 FTEs serve all 12 task forces)
• Formulary manager: Clinical pharmacists who provide logistical support for multiple task forces, including coordinating communication around shortages (3 FTEs, plus 1.5 FTE administrative assistant)
• All formulary and contract portfolio managers are clinical and administrative pharmacists employed by supply chain management, a part of Mayo Clinic Shared Services.

The Pharmaceutical Formulary Committee creates prescribing guidance to ensure that there is one set of rules across the hospitals and clinics. No safe drugs are excluded from the formulary, though guidance is given for appropriate use.

For each drug, the formulary does the following:

Aligns with health plan
Each drug is given a tier that corresponds with its copay and coinsurance levels.

Embeds care pathways
Dynamic prescribing algorithms are used to ensure appropriate and cost-effective care.

Allows flexibility for specialty variation
Guidance for each drug varies by specialty and site of care.