Typical profile of a drug to be included in the hospital formulary

Hospital Formulary

The hospital formulary is a continuously revised compilation of pharmaceutical dosage agent and their forms etc. which reflects the current clinical judgment 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 mot useful in the patient care. the hospital formulary system provides the information for procuring,prescribing, dispencing and administrative of drug under non proprietary names and instance where drugs have both names.

The hospital formulary system is a method whereby the medical staff of a hospital with the help of pharmacy and therapeutic committee , selects and evaluates medicinal agents and their dosage forms which are considered to be most useful in the patient care. it provides information for Procuring, Prescribing, Dispensing And administration of drugs under brand names where the drug have both names.

Types of hospital formularies

There are three basic types of formularies- open, closed or restricted and incentive based.

An open formulary serves merely as a guide; a physician may prescribe any drug, but is encouraged to use the formulary list in prescribing decisions.

In contrast, a closed or restricted formulary lists the drugs that will be reimbursed by the health care provider; non-formulary drugs will be reimbursed only if they are authorised prior to prescribing.

An incentive-based formulary represents a hybrid between the open and closed formularies; patients pay a higher price for non formulary drugs.

ADVANTAGES AND DISADVANTAGES OF HOSPITAL FORMULARY

Hospital formularies, which are lists of medications approved for use within a particular healthcare institution, offer several advantages and disadvantages:

Advantages:

1. Standardization of Care: Hospital formularies help standardize the selection of medications used within the institution. This promotes consistency in treatment approaches among healthcare providers, which can improve patient outcomes and reduce the risk of medication errors.
2. Cost Control: By limiting the selection of medications to those included in the formulary, hospitals can negotiate better prices with pharmaceutical suppliers and achieve cost savings. Formularies often include generic alternatives and medications with favorable pricing arrangements, helping to manage healthcare expenditures.
3. Quality Assurance: Drugs included in hospital formularies have typically undergone rigorous evaluation for safety, efficacy, and quality. This provides assurance to healthcare providers and patients that the medications used within the institution meet established standards and regulatory requirements.
4. Streamlined Procurement and Inventory Management: With a standardized list of medications, hospitals can streamline the procurement and inventory management processes. This reduces administrative burden, minimizes medication stockouts, and ensures that essential medications are readily available for patient care.
5. Clinical Decision Support: Hospital formularies may incorporate clinical guidelines and evidence-based recommendations for medication use. This supports healthcare providers in making informed decisions about drug therapy, optimizing treatment outcomes, and adhering to best practices.

Disadvantages:

1. Restrictions on Treatment Options: Hospital formularies limit the selection of medications available to healthcare providers, which may restrict access to certain drugs that could be beneficial for specific patients. This can lead to challenges in tailoring treatment regimens to individual patient needs and preferences.
2. Clinical Variation: Differences in hospital formularies across institutions can result in clinical variation in medication selection and treatment practices. This may lead to disparities in patient care and outcomes, particularly for conditions with multiple therapeutic options or evolving treatment guidelines.
3. Physician Discontent: Healthcare providers may experience frustration or dissatisfaction if their preferred medications are not included in the hospital formulary. This can impact provider morale, autonomy, and perceptions of professional autonomy.
4. Delayed Access to New Therapies: Hospital formularies may lag behind in incorporating new medications and therapeutic advances, as drugs must undergo evaluation and approval before inclusion. Patients may experience delays in accessing innovative treatments that are not yet included in the formulary.
5. Administrative Burden: Maintaining and updating a hospital formulary requires ongoing review of medication safety, efficacy, and cost-effectiveness. This can impose administrative burden on formulary committees, pharmacy staff, and healthcare administrators, particularly in larger healthcare systems.

GUIDELINE FOR HOSPITAL FORMULARY

1. The governing body of the hospital shall appoint a pharmacy and therapeutic committee composed of physician and pharmacist which will prepare the hospital formulary system.
2. The medical staff in the governing body shall sponsor and outline the purpose,organisation function and scope of the hospital formulary system. it should adopt the principle as per the need of particular hospital.
3. The pharmacy and therapeutic committee shall develop policy and procedure governing the hospital formulary and the medical staff shall adopt these policies and procedures subject to administrative approval
4. The policy and procedures shall afford guidance in the appraisal, selection, procurment, storage, distribution, use, safety procedures and other matter relating to drug in the hospital and shall be published in the hospital’s formulary or other media available to the member of medical staff.
5. To ensure the maintenance of the responsibility and procreative of the physician in the exercise of his professional judgment.
6. The medical staff shall adopt the policy formula, and procedure for including drugs in the formulary by their non proprietary names even though proprietary names even though proprietary names continue to being use in the hospital physicians. He may be encouraged to prescribe drug under their non proprietary names, although nomenclature used in entirely a matter of individual practisner’s discretion.
7. In the absence of written policies approved by the medical staff related to the operation.

Steps involved in the preparation of hospital formulary

Identify the most common diseases being treated in the hospital by consulting all medical departments. For each disease, an appropriate first choice of treatment should be identified using standard treatment guidelines. An expert committee can be brought together to identify the appropriate treatment for each of the common health problems.

The alternative method is reviewing the WHO model list of essential medicines may also be used as a starting point. The capability of the hospital and its staff to handle specific drugs should not be forgotten during the selection process. All information should be discussed with evidence based reviews where possible.

Contents of each drug monograph: The drug monograph consists of following subheadings such as non-proprietary name of drug, synonyms, available brands and cost, reconstitution and administration, dosage forms, Indications, contraindications, precautions, dose, pregnancy risk factors, adverse effects and interactions.

Managing a formulary list (Adding and deleting drugs): For a new medicine to be added into the hospital formulary, the committee should consider the therapeutical equivalency to existing drugs in terms of efficacy, safety, or convenience of dosing/administration. For the addition and deletion of drugs the total cost for a course of treatment with new medicine should be compared with the already listed medicines.

Role of Pharmacist

• Pharmacist in the DTC has a key role in developing policies and procedures governing the hospital formulary.
• The chief pharmacist has the primary responsibility for the
  preparation of hospital formulary.
• Pharmacist with the advice and guidance of DTC shall as certain the quantity and source of supply of all drugs, chemicals, biological and pharmaceutical preparations used for the diagnosis, and treatment of patients.
• Pharmacist should ensure that quality of drugs is not compromised by economic considerations.

Conclusion

Hospital formulary promotes evidence based standard practice. It will ensure the clinical efficacy, patient safety and cost effective prescriptions for the rational drug use by identifying effective and safe medications. It provides impartial drug information to counteract biased promotional activities. Pharmacist plays a key role in developing policies and procedures governing the hospital formulary. When a formulary is used effectively, it becomes the cornerstone, which can be one of the most effective methods of ensuring rational drug therapy and controlling drug cost.

Reference

1. Godwin HN, Scott MS. Institutional patient care. In: Alfonso RG. Remington The science and practice of pharmacy. 20 Ed. New York: Lippincott Williams and Wilkins; 2000. 1911-31.
2. Lexchin J. General Practice Formularies: The Way Ahead? Can Fam Physician 1989; 35:1569-70.
3. Managing the formulary process. In: Holloway K, Green T. Drug and therapeutics Committees A practical guide. France: World Health Organisation; 2003. 15-34.