A hospital formulary is an essential tool that supports rational, safe, and cost-effective medication use within a healthcare institution. It is more than just a drug list—it represents a systematically developed resource that guides physicians, pharmacists, and nurses in selecting and using medicines. Formulary management helps standardize treatment, reduce unnecessary drug variation, control costs, and ensure quality patient care.
Definition
A hospital formulary is a continuously updated compilation of approved pharmaceutical agents and their standard dosage forms, agreed upon by the medical staff based on clinical evidence and therapeutic value.
Hospital Formulary System
The hospital formulary system is a structured method through which the Pharmacy and Therapeutics Committee (PTC) evaluates, selects, and reviews medications available for use in the hospital. It provides essential information for procuring, prescribing, dispensing, and administering drugs.
Origin of Hospital Formulary in India
- The first Indian hospital formulary was published in 1968 by the Department of Pharmacy, CMC Vellore.
- Government medical colleges began formulating their own hospital formularies by 1997, starting with Trivandrum Medical College, Kerala.
Advantages of Hospital Formulary
- Promotes rational and evidence-based drug therapy.
- Helps control escalating drug costs.
- Reduces variation in prescribing patterns among clinicians.
- Improves inventory control and reduces unnecessary stock.
- Provides concise, updated, and easy-to-use drug information.
- Improves communication between medical, nursing, and pharmacy staff.
- Supports adherence to standard treatment guidelines.
Disadvantages of Hospital Formulary
- May limit physicians’ flexibility in prescribing their preferred brands.
- Risk of purchasing lower-quality products if no qualified pharmacist participates.
- Patients may not benefit from reduced drug costs even if hospitals buy in bulk.
- If poorly maintained, the formulary may become outdated and clinically irrelevant.
Types of Hospital Formularies
- Open Formulary: Acts as a prescribing guide; clinicians may use non-formulary drugs freely but are encouraged to use formulary options first.
- Closed/Restricted Formulary: Only listed drugs are allowed unless special authorization is obtained.
- Incentive-Based Formulary: Patients pay higher charges for non-formulary medicines, encouraging formulary compliance.
Members Involved in Formulary Development
The Pharmacy and Therapeutics Committee oversees formulary preparation. Members usually include:
- Physicians from major specialties (medicine, surgery, pediatrics, obstetrics, etc.).
- A clinical pharmacologist (if available).
- A nurse representative.
- Chief pharmacist or deputy chief pharmacist.
- Hospital administrator or finance representative.
- A microbiologist or laboratory scientist.
- A records department representative.
Criteria for Medicine Selection
Drug selection is based on multiple factors such as:
- Prevalence of diseases in the community.
- Available treatment facilities and staff competency.
- Evidence of safety, efficacy, and therapeutic advantage.
- Cost effectiveness and total treatment cost.
- Stability and quality of the drug product.
- Pharmacokinetic properties and dosage convenience.
- Availability of appropriate formulations.
WHO Selection Criteria (1999)
- Medicines must have sound clinical evidence for efficacy and safety.
- They should be stable, assure bioavailability, and meet quality standards.
- If two drugs are similar, the better option is chosen based on cost-effectiveness, safety, and availability.
- Essential medicines should preferably be single-ingredient formulations unless combinations offer proven benefits.
Guidelines for Hospital Formulary
- The governing body appoints a PTC to oversee formulary development.
- Policies and procedures must be documented and approved by the medical staff.
- Drug selection, procurement, storage, distribution, and safety procedures should be clearly outlined.
- Physicians must be informed about formulary policies and updates.
- Terminology like “substitution” must be avoided to prevent confusion.
- Changes in formulary content must be communicated promptly.
Steps in Preparing a Hospital Formulary
- Identify the most common diseases treated in the hospital.
- Use standard treatment guidelines or WHO essential medicines list as a reference.
- Consult clinical departments to identify drug needs.
- Prepare a draft drug list for departmental review.
- PTC evaluates feedback and finalizes the list.
- Create drug monographs with unbiased therapeutic information.
Contents of a Drug Monograph
- Non-proprietary name and synonyms.
- Available brands.
- Cost and dosage form.
- Reconstitution and administration details.
- Indications, contraindications, and precautions.
- Dosage, pregnancy category, and adverse effects.
- Drug interactions.
Managing the Formulary (Adding & Deleting Drugs)
- New medicines should be evaluated for therapeutic superiority, cost, and safety.
- If a new drug is added, older alternatives for the same indication should be reviewed and possibly removed.
- Cost comparison must include total treatment cost, not just unit price.
Maintaining the Formulary
- The formulary should be reviewed every 2–3 years.
- Therapeutic classes must be evaluated systematically.
- Regular review of drug-use problems and non-formulary drug requests.
- All decisions must be documented and archived.
Improving Formulary Adherence
- Review non-formulary medicine use regularly.
- Ban non-formulary drug samples.
- Ensure easy access to formulary (printed copies, pocket manuals).
- Promote formulary changes through internal communication.
- Provide clear guidelines for therapeutic interchange.
Examples of Standard Formularies
- WHO Model Formulary
- British National Formulary (BNF)
- Indian National Formulary
- CMC Vellore Hospital Formulary
- Manipal Hospital Formulary
Role of Pharmacist in Hospital Formulary
- Lead the preparation and revision of the formulary.
- Ensure drug quality, safety, and economical purchasing.
- Maintain accurate drug information resources.
- Coordinate with the PTC for policy development.
- Monitor supply chain and prevent procurement of substandard products.
Detailed Notes:
For PDF style full-color notes, open the complete study material below:
PATH: PHARMD/ PHARMD NOTES/ PHARMD FOURTH YEAR NOTES/ HOSPITAL PHARMACY/ HOSPITAL FORMULARY.