Walk through a hospital pharmacy store and count the proton-pump inhibitors: omeprazole, pantoprazole, esomeprazole, rabeprazole, often in two brands each. Each one is a tender line, a stock line, a reorder point and a price. Clinically, for most indications, they are interchangeable. Commercially, you are paying for the privilege of not choosing.
Where the money is
Class-level tendering means the hospital tenders for “a proton-pump inhibitor, oral 20/40 mg and IV 40 mg, estimated annual volume X”, and lets suppliers compete across molecules. The winning molecule becomes the formulary default; the others stay available on restriction. In our experience the saving on the category is 20–40%, with the larger figure where the previous mix was brand-heavy. The same logic applies to ARBs, statins, third-generation oral cephalosporins, second-generation antihistamines, inhaled corticosteroid combinations and low-molecular-weight heparins (where biosimilars exist).
What the P&T committee needs
- A short list, not a blank page. Bring the class, the molecules, the current consumption and spend by molecule, and the candidate default. The Drug & Alternatives Look-up gives you the class members and notes in seconds.
- The exceptions written down. Which patients stay on the non-default molecule (paediatric formulations, specific interactions, documented intolerance) and how a prescriber requests it.
- Registration and supply evidence. Every candidate registered with the authority, two sources of supply, shelf life on delivery ≥ 12 months.
- The switch plan. Run-down of existing stock, HIS order-set changes, a one-page clinician note, and a 90-day review of adverse events and complaints.
Where not to do it
Narrow-therapeutic-index drugs (levothyroxine, warfarin, phenytoin, tacrolimus, lithium) are not candidates for brand switching without clinical monitoring. Modified-release products with different release profiles are not interchangeable. Biologics follow a separate biosimilar-switch policy with pharmacovigilance. The look-up flags these.
Sequence for a group
Start with the two or three classes with the largest spend and the least clinical sensitivity — PPIs, statins, ARBs. Tender them as class lots in the next cycle. Report the saving reconciled to the ledger. Then extend. Groups that do this across ten classes typically take 8–12% off total drug spend within 18 months without touching a single high-cost specialty line.