Pharmacy

Formulary

Commercial drug formulary

Our drug-formulary process results in a constantly updated list of drugs that has been approved for our members by the Southern California Kaiser Permanente Pharmacy and Therapeutics Committee (P&T). This medical group committee thoroughly reviews medical literature and selects drugs for the formulary based on numerous factors, including safety, effectiveness, and affordability. Every SCPMG provider, through their local P&T, has an opportunity and is encouraged to participate in the formulary decision-making process, including requests for formulary additions, deletions, and status changes

Drugs and supplies included on the drug formulary are covered under a member’s drug benefit. To be covered under the drug benefit, prescriptions must be dispensed from a Kaiser Permanente pharmacy, Kaiser Permanente mail-order pharmacy, or an affiliated network community pharmacy designated by the health plan (special out-of-network exceptions may apply). Please direct patients to Kaiser Permanente customer service with all questions regarding their network pharmacy benefit.

For more details on our commercial formulary and related pharmacy policies, services and contact information, search our consumer online drug formulary (courtesy of Lexi-Comp)

Medicare Part D drug formulary

Our Medicare Part D drug formulary is a list of the prescription drugs that are approved for coverage by Kaiser Permanente Senior Advantage Plan. For details relating to the drug formulary and pharmacy information for Senior Advantage (HMO) and (HMO-SNP), search our 2012 Medicare Part D formulary.

Information on the following topics is also available on the kp.org drug formulary and pharmacy pages:

Using the formulary
Changes to the formulary
Getting an exception to the formulary
Transition process for medications
Kaiser Permanente pharmacies
Out-of-network pharmacy coverage
Rx refills and mail order services
Other important Medicare Part D information
Contact information

Pharmacy and Therapeutics Committee

The Regional Pharmacy and Therapeutics (P&T) Committee – with expert guidance from various clinical specialists who serve as ad-hoc consultants – evaluates, appraises, and selects from available drugs those considered to be the most appropriate (safe, effective, and cost-effective) for patient care and general use within the Southern California region.

Key characteristics of the P&T formulary management process include:

A physician-driven, dynamic, evidence-based process
Collaboration with SCPMG Chiefs of Services Groups and expert consultants
The assistance of a dedicated group of Pharmacist Evidence Analysts & Strategists
Formulary decisions made at bi-monthly (i.e., every 2 months) meetings

Any SCPMG physician may request formulary additions or deletions.

Medication Safety and Quality

Medication safety adverse-event reporting

Visit the FDA MedWatch website for the latest in clinically important safety information related to drugs and human medical products.

Institute for Safe Medication Practices

The Institute for Safe Medication Practices (ISMP), based in suburban Philadelphia, is the nation’s only 501(c)(3) nonprofit organization devoted entirely to medication error prevention and safe medication use. ISMP represents over 35 years of experience in helping healthcare practitioners keep patients safe, and continues to lead efforts to improve the medication use process. The organization is known and respected worldwide as a resource for impartial, timely, and accurate medication safety information. For more information, visit the ISMP website*.

National Committee for Quality Assurance (NCQA) – HEDIS Measures

The National Committee for Quality Assurance (NCQA) is a private, 501(c)(3) not-for-profit organization dedicated to improving health care quality. Since its founding in 1990, NCQA has been a central figure in driving improvement throughout the health care system, helping to elevate the issue of health care quality to the top of the national agenda. To find out more about HEDIS medication-related quality measures, visit the NCQA home page* where you may download the List of Measures.

Examples of current measures include:

Avoidance of Antibiotic Treatment for Adults with Acute Bronchitis
Use of Appropriate Medications for People with Asthma
Appropriate Treatment for Children with Upper Respiratory Infection
Annual Monitoring for Patients on Persistent Medications
Drugs to Avoid (High Risk Medications)in the Elderly
Drug-Disease Interactions
Persistent Beta Blocker Use after Acute Coronary Event

AWARE, the Alliance Working for Antibiotic Resistance Education, initiated by the California Medical Association (CMA) Foundation, is a long-term, statewide effort to promote the appropriate use of antibiotics. The partnership includes physician organizations, healthcare providers, health systems, health plans (including Kaiser Permanente), public health agencies, consumer and community based organizations, federal, state and local government representatives, and the pharmaceutical industry.

Mission: Reduce the unnecessary use of antibiotics and reduce the prevalence of antibiotic-resistant bacteria in California.

To read more about this program and how you can help educate those we care for, visit the AWARE website.