THE HOSPITAL FORMULARY

Bilal Hassan
M.Phil Pharmaceutics
 FORMULARY

 A formulary: is a list of medicines. Traditionally, a formulary contained a collection of formulas for

the compounding and testing of medication (as a pharmacopoeia today). Today, the main function
of a drug formulary is to specify particular medications that are approved to be prescribed at a
particular hospital, in a particular health system. The development of formularies is based on
evaluations of efficacy, safety, and cost-effectiveness of drugs.

 National Formulary: National formulary is a compilation of all drugs available in a country. A

National formulary must provide information on drugs for prescribers in a user-friendly form
 HOSPITAL FORMULARY

 The hospital formulary is a list of pharmaceutical agents with its important information which
reflects the current clinical views of the medical staff.

 The hospital formulary system is a method whereby the medical staff of a hospital with the
help of pharmacy and therapeutic committee selects and evaluate medical agents and their
dosage form which are considered to be most useful in the patient care. The hospital
formulary system provides the information for procuring, prescribing, dispensing and
administering of drugs under non-proprietary or proprietary (brands) names in instances
where drugs have both names.
 GUIDELINES FOR COMPILING A
FORMULARY

 The following principles will serve as a guide to physicians, pharmacists; Nurses, and
administrators in clinical facilities utilizing the formulary system:
 The medical staff shall appoint a multidisciplinary pharmacy and Therapeutic committee and
outline its purposes, organization, function, and scope.
 The medical staff shall adopt written policies and procedures governing formulary
system as developed by pharmacy and therapeutics committee. These policies and procedures
shall provide guidance in evaluation, selection, procurement, storage. distribution, safe use, and
other matters relating to drugs.
 Drugs should be included in the formulary by their nonproprietary names even though
proprietary names may be in common use in institution. Prescribers should be strongly
encouraged to prescribe drugs by their nonproprietary names.
 GUIDELINES FOR COMPILING A
FORMULARY

 P&TC must set policies governing the dispensing of generic equivalents and therapeutic
equivalents. These policies should include the following:
 Pharmacist is responsible for selecting from available generic equivalents, those to be
dispensed following physician's order for a particular drug product.
 A prescriber has an option at the time of prescribing to specify the brand of drug to be
dispensed for that particular medication order/prescription. However, The prescriber's
decision should be based on pharmacologic or: therapeutic considerations.
 The institution shall ensure that its medical and nursing staffs are informed about the
existence of the formulary system, the procedures governing its operation, and any
modifications.
 GUIDELINES FOR COMPILING A
FORMULARY

 Copies of the formulary must be readily available and accessible at all times.
 Provision shall be made in the formulary system for appraisal and use of non. formulary
drugs, by the medical staff.
 The pharmacist shall be responsible for specifications as to the quality, quantity, and source
of supply of all pharmaceutical preparations and allied substances used in diagnosis and
treatment. When applicable, such products should meet the official standards.
 OBJECTIVES OF FORMULARY

 The primary objectives of a formulary are to provide the hospital staff with the
information on:
 The drugs approved for use by the pharmacy and therapeutics committee.
 Basic therapeutics of each approved item.
 Hospital policies and procedure governing use of drugs.
 Special aspects such as drug dosing rules and hospital approved abbreviations
etc.
 ADVANTAGES OF FORMULARY
SYSTEM

 The formulary system offers the following advantages:

 PROVIDES THERAPEUTIC MERITS:
 Under formulary system, drugs are carefully evaluated, appraised and selected from
among multiple drug products in terms of their safety, efficacy and cost effectiveness.
Thus, a formulary system provides the greatest benefit to the patients and physicians in
that only the most efficient products are listed and available.
 PROMOTES RATIONAL PRESCRIPTION:
 A formulary recommends inclusion of specific drugs while exclude others. This coupled
with the guidelines to assist prescribers in using the drugs in a formulary and specific
treatment protocols enhance the rational drug prescription to the patients.
 ADVANTAGES OF FORMULARY
SYSTEM

 PROMOTES COST EFFECTIVENESS:

 A formulary contains selected drugs and eliminates brand duplication thus reducing
inventory duplication, easier cash flow and the opportunity for volume purchasing. All
contribute to lower cost to the patients., Formulary encourages generic prescription
which may further reduces the cost. This program is the basis of appropriate,
economical drug therapy.
 POSSESS EDUCATIONAL VALUE:
 The formulary contains various prescribing tips and drug information of educational
value thus being beneficial for medical staff and nurses.
 ADVANTAGES OF FORMULARY
SYSTEM

 PROMOTES KNOWLEDGE:
 Prescribers, who use a restricted range of drugs listed on the formulary, know
more about these drugs and their formulations. Increased knowledge reduces the
risk of inappropriate prescribing, interactions or lack of efficacy.
 CLOSE EXPIRY MONITORING:
 Formulary makes the possibility of a close drug monitoring for expiry dates as
under this system only limited and fewer products are stocked.
 POSSIBLE DEMERITS OF FORMULARY

 Use of a formulary system in an institution has relatively few disadvantages:

 Deprives the physician's freedom to prescribe and obtain brands of his preference,
Changing prescribing habits is difficult to achieve. Sometimes constant reminders
are necessary to maintain prescribing with the recommendations of a formulary,
consuming pharmacist's time that could be spent in another beneficial activities.
 Permits pharmacist to act as the sole judge to select brands of drugs for
purchasing and dispensing.
 Allows purchase for inferior Quality as there may not be an appropriate
selection criteria, particularly in institutions where there is no staff pharmacist.
 Unable to reduce cost of drugs to the patient. Most of the institutions purchase
large volumes of drugs at reduced rates but do not pass on reduction in costs to
the patients.