Therapeutic decision-making: a model for formulary evaluation

Considerations in Deciding Which Drugs Should Be in a Formulary

The formulary is a compendium of pharmaceuticals, along with important drug information, that reflects the current clinical judgment of the medical and pharmacy staffs of an organization. Sound formularies have been shown to have a positive effect on prescribing. Poor formularies, those with too many marginal, obsolete, or redundant drugs, may contribute to less than ideal therapy in some patients, and probably at more expense. At the core of a sound formulary is having sound criteria and procedures for adding drugs. Such criteria should be general and specific. Should there be separate criteria for adding new drugs? For antibiotics? For biotechnology drugs? Criteria for maintaining and deleting drugs should also be in place. This keeps the formulary up-to-date and viable. Even with sound criteria, the process of adding, maintaining, and deleting drugs can be flawed by pressures, outside and inside organizations. However, such barriers can be overcome. The process of evaluating drugs for formulary status has been changing. New techniques are being developed to make the process more objective, more scientific, and more patient-outcome-driven.

Quality control of hospital formularies

This paper identifies various uses of the formulary concept, outlines factors that underlie the need for such an administrative device, and reviews four barriers to effective formulary control. It then examines selected components of the formulary system and specifies the need for supporting techniques, both internal and external. Twelve guidelines for developing a model drug formulary are presented. While administrative elements associated with implementation of a formulary are stressed, concerns about more intangible behavioural forces are introduced.