Formulary (pharmacy)

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At its most basic level, a formulary is a list of medicines.[1] Traditionally, a formulary contained a collection of formulas for the compounding and testing of medication (a resource closer to what would be referred to as a pharmacopoeia today). Today, the main function of a prescription formulary is to specify particular medications that are approved to be prescribed under a particular insurance policy. The development of prescription formularies is based on evaluations of efficacy, safety, and cost-effectiveness of drugs.

Depending on the individual formulary, it may also contain additional clinical information, such as side effects, contraindications, and doses.

By the turn of the millennium, 156 countries had national or provincial essential medicines lists and 135 countries had national treatment guidelines and/or formulary manuals.

Australia[edit]

In Australia, where there is a public health care system, medications are subsidised under the PBS and medications that are available under the PBS and the indications for which they can be obtained under said scheme can be found in at least two places, the PBS webpage (http://www.pbs.gov.au/pbs/home) and the Australian Medicines Handbook.

United States[edit]

In the US, where a system of private healthcare is in place, a formulary is a list of prescription drugs available to enrollees, and a tiered formulary provide financial incentives for patients to select lower-cost drugs. For example, under a 3-tier formulary, the first tier typically includes generic drugs with the lowest cost sharing (e.g., 10% coinsurance), the second includes preferred brand-name drugs with higher cost sharing (e.g., 25%), and the third includes non-preferred brand-name drugs with the highest cost-sharing (e.g., 40%).[2]

When used appropriately, formularies can help manage drug costs imposed on the insurance policy.[2] However, for drugs that are not on formulary, patients must pay a larger percentage of the cost of the drug, sometimes 100%. Formularies vary between drug plans and differ in the breadth of drugs covered and costs of co-pay and premiums. Most formularies cover at least one drug in each drug class, and encourage generic substitution (also known as a preferred drug list).[3]

From Express Scripts (Largest PBM in the US):

"Drug Formulary Management. Formularies are lists of drugs to which benefit design is applied under the applicable plan. Formulary management enables patients and physicians to choose clinically appropriate and cost-effective drugs for a given condition. Our foremost consideration in the formulary development process is the clinical appropriateness of the particular drugs. In developing formularies, we first perform a rigorous assessment of the available evidence regarding each drug’s safety and clinical effectiveness. No new drug is added to the formulary until it meets standards of quality established by our National Pharmacy & Therapeutics (“P&T”) Committee, a panel composed of 16 independent physicians and pharmacists in active clinical practice, representing a variety of specialties and practice settings, typically with major academic affiliations. We fully comply with the P&T Committee’s clinical recommendations. In making its clinical recommendation, the P&T Committee has no information regarding the discount or rebate arrangement we might negotiate with the manufacturer. This is designed to ensure the clinical recommendation is not affected by our financial arrangements. After the clinical recommendation is made, the drugs are evaluated on an economic basis to determine optimal cost effectiveness. We administer a number of different formularies for our clients. A majority of our clients select formularies that are designed to be used with various financial or other incentives, such as three-tier co-payments, which drive the selection of formulary drugs over their non-formulary alternatives. Some clients select closed formularies, in which benefits are available only for drugs listed on the formulary. We also provide formulary compliance services to our clients. For example, if a doctor has prescribed a drug that is not on a client’s formulary, we notify the pharmacist through our claims processing system. The pharmacist may then contact the doctor to attempt to obtain the doctor’s consent to change the prescription to the appropriate formulary product. The doctor has the final decision-making authority in prescribing the medication."[4]

United Kingdom[edit]

In the UK, the National Health Service (NHS) provides publicly funded universal health care, financed by national health insurance. Here, formularies exist to specify which drugs are available on the NHS. The two main reference sources providing this information are the British National Formulary (BNF) and the Drug Tariff. There is a section in the Drug Tariff, known unofficially as the "Blacklist", detailing medicines which are not to be prescribed under the NHS and must be paid for privately by the patient.

In addition to this, local NHS hospital trusts and Primary Care (General Practitioners) Clinical Commissioning Groups (CCGs), produce their own lists of medicines deemed preferable for prescribing within their locality or organisation; such lists are usually a subset of the more comprehensive BNF. These formularies are not absolutely binding, and physicians may prescribe a non-formulary medicine if they consider it necessary and justifiable. Often, these local formularies are shared between a PCOs and hospitals within that PCO's jurisdiction, in order to facilitate the procedure of transferring a patient from primary care to secondary care, thus causing fewer "interfacing" issues in the process.

As in the United States, the NHS actively encourages generic prescribing, in order to save more of the budget allocated to them by the Department of Health.

National formulary of India [NFI][edit]

The National Formulary of India would prove to be the authoritative guide to prescribing, dispensing and administering medicines for all healthcare professionals. It will be useful for framing national drug policies in the country. Ministry of Health and Family Welfare, Govt. of India vide its notifications F. No. X. 11035/2/06-DFQC, dated 8 May 2008 assigned this mandatory responsibility to the Indian Pharmacopoeia Commission, Ghaziabad to publish NFI on regular basis.

History of NationalFormulary of India (NFI):

The IPC with its mission to be one of the leading scientificinstitutions under the central government puts stress on keeping transparency,accountability and punctuality and the publication of the NFI.

The National Formulary of India editions are as follows: -

1--National Formulary of India 1960 -The first edition of NFI

2--National Formulary of India 1966 -The Second edition of NFI

3--National Formulary of India 1979 –The Third edition of NFI

4--National Formulary of India 2011; Fourth Edition [5]

5--CD-ROM of National Formulary of India

Procurement of Indian Pharmacopoeia (IP) and National Formulary ofIndia (NFI):-

The Indian Pharmacopoeia can be procured from Office of the Secretary-cum-Scientific Director, Indian Pharmacopoeia Commission at CIPL Campus, Rajnagar, Sector-23, Ghaziabad – 201 002 (UP) through demand draft in favour of “Secretary-cum-Scientific Director, Indian Pharmacopoeia Commission” payable at Ghaziabad, Uttar Pradesh. The same can be procured from our authorized distributors in India through our distribution network.A national formulary contains a list of medicines that are approved for prescription throughout the country, indicating which products are interchangeable. It includes key information on the composition, description, selection, prescribing, dispensing and administration of medicines. Those drugs considered less suitable for prescribing are clearly identified.

Examples of national formularies are:

See also[edit]

References[edit]

  1. ^ Formulary Definition
  2. ^ a b [1] The New Medicare Drug Benefit: Formularies and Their Potential Effects on Access to Medications
  3. ^ New York State Department of Health
  4. ^ http://www.sec.gov/Archives/edgar/data/1532063/000153206314000006/esrx-12312013x10k.htm
  5. ^ http://ipc.nic.in/printcont.asp?lid=100&EncHid=
  6. ^ a b c FASS – the Swedish Medicines Information Engine information booklet from The Swedish Association of the Pharmaceutical Industry (LIF). Updated 2008

External links[edit]