CHAPTER 5
HOSPITAL FORMULARY
Saima Asghar
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Contents
• Introduction
• General Principles and guidelines to develop Formulary
• Format
• Preparation of the Formulary
• Role of Pharmacist
• Benefits and problems
Introduction
A formulary is a list of drugs approved for use in a given setting, such as
within:
• Hospitals and Health Systems
• Employer Groups
• Managed Care Organizations
• Pharmacy Benefit Managers
• Government agencies
General Principles and guidelines to
develop Formulary
The formulary generally:
• Offers one or more therapeutic options per disease category
• Facilitates purchasing and prescribing
• Helps to manage cost by reducing duplication
• Formularies are often used as a negotiating tool with drug
manufacturers
• Drug manufacturers may offer discounts (i.e. rebates) for drugs that
are placed on the formulary
• The governing body of the hospital should appoint a P&TC which will
prepare the hospital formulary system.
• P&TC will sponsor and outline the purpose, organization function and
scope of the hospital formulary.
• It should adopt the principles as per the need of particular hospital.
• P&TC develop policies and procedures to medical staff.
• Prescribers are strongly encouraged to prescribe drugs by their non-
proprietary names.
• Medical and nursing staff are informed about the changes in the
hospital formulary.
Formulary content, format and
organization
Primary objectives:
• Information on drugs/ drug products listing
• Information on hospital policies and procedures
• Special information about drugs
Hospital policies and procedures
• Drug use
• Description of P&TC
• Hospital regulations about prescribing, dispensing and administration
of drugs, rules for medical reps. Emergency drug products
• Pharmacy operating procedures
• Information on using formulary
Drugs products listing
Formulary item entries:
• Alphabetically by generic name
• Alphabetically within therapeutic class
• Type of information
• Dosage form
Types of information
• Dosage form, strength, packaging
• Active ingredients
• Cost
Indexes to the drug products listing
• Generic name/brand name
• Therapeutic/pharmacological index
Special information
• Equivalent dosages of similar drugs
• Hospital approved abbreviations
• Rules for calculating pediatric dosages
• List of sugar free drugs
• List of dialyzable poisons
• Metric conversion tables
• Poison control information
• Table of drug interactions
Preparation of formulary
• Visually pleasing, easily readable and professional in appearance
• A typical formulary must have following compositions:
Title page
Names and titles of the members of the P&TC
Table of contents
Information on hospital policies and procedures concerning drugs
Products accepted for use at hospital
Appendix
Table of contents
a. Introduction
• List of abbreviations
• List of drugs used in formulary
b. Basic information on each drug
• Efficacy for the treatment of specific conditions
• Safety profile of the item
• Interaction profile
• Adverse effects
• Pharmacokinetic profile
• Availability of the item
• Available dosage form
• Cost
• Acceptability to patients
c. Supplementary information on each drug
• Storage guidelines
• Patient counselling information
• Labeling information
• Brand names and prices
d. Prescribing and dispensing guidelines
• Principles of prescription writing
• Reporting of ADRs
• Prevention of ADRs
e. General drug use and advice
• Use of IV drugs
• Special situation like pregnancy, breast feeding, liver/kidney disease
• Poisoning information and antidotes
• Treatment of snakebites and insect bites
f. Miscellaneous section
• Children dose
• Renal adjustments
• Metric units
• Diagnostic aids
Role of pharmacist
• Drug selection
• Promoting formulary adherence
• Review and action on all non-formulary drug use in the hospital
• Providing a copy of the hospital formulary to all doctors in the
hospital
• Involve the medical staff in various formulary implementing programs
• Give much advertisement and publicity regarding formulary
• Revision of formulary
Advantages of formulary Disadvantages of formulary
• Ensure quality and • Only reduces cost
appropriateness of drugs • Compromises patient care
• Economic benefits • Limit physician’s prescribing
• Educational for staff regarding authority
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