In this exclusive Hospital Formulary interview, Louise Riff, MD, and Richard Hutchinson, PharmD, highlight the challenges of their 15-year tenure as the Chairman and Secretary of the University of Illinois Hospital P & T Committee. While continuity in formal leadership has been advantageous, they also attribute part of their success to the diverse informal leadership that develops each year. Drs. Riff and Hutchinson discuss how the P & T Committee has become accomplished at making what once were controversial decisions, such as removing the number one drug from their formulary as a cost-containment strategy. They also describe the recent development of an improved ADR reporting system and the progress in exchanging formulary decisions with neighboring hospitals. This P & T Committee, however, expresses some discomfort with the evaluation of high-tech drug products, since significant cost implications without therapeutic guarantees create new dimensions in decision-making for their Committee.