Managing medicines: Formularies

Last updated: Monday, February 15, 2016

Every hospital in England has a formulary which describes the medicines that the Pharmacy department has readily available in stock for prescribers. Some of the advantages suggested for adopting a local formulary include:

  1. It restricts the stock of medicines that Pharmacy must hold; there would not be enough space for a hospital Pharmacy to stock every single medicine that is marketed. 
  2. Since Pharmacy can’t stock everything, then healthcare professionals are encouraged to choose the most appropriate medicines for their formulary that meet local need. When choosing, they consider effectiveness, safety, patient convenience, and value for money. 
  3. Instead of keeping, say, ten medicines of the same type a hospital might keep just two, and this increases Pharmacy’s ability to negotiate a discount when purchasing. 
  4. If prescribers have a limited range of medicines to choose from, they become more familiar with them and this reduces the risk of errors. 
  5. If a Pharmacy keeps a very wide range of medicines, then lots of them will not get used, go out of date, and have to be thrown away. 

There are further advantages if your Trust has a joint formulary with primary care because local GPs are encouraged to use the same medicines as their colleagues in hospital, and vice versa. This means that the hospital should automatically have these medicines available if a patient is admitted to hospital.

Although we have concentrated on the list of medicines that a formulary contains, many formularies have other content as well. Some will advise about the preferred first choice medicine for a condition, or specify that only specialists can prescribe certain medicines. Your formulary may also have detailed guidance on treating a range of conditions, or advise on drug administration. If you’d like to see a detailed formulary that is more than just a list of medicines, then look at the Evelina London Paediatric Formulary.

NICE have produced guidelines on developing and updating local formularies. These say that all organisations should publish their formulary and all other information relevant to the formulary online, so most hospitals publish their formulary on their external website, but your Trust may issue a paper copy too.

  • Find out where your hospital’s formulary is published, and become familiar with the way it is organised. 
  • Is it a joint formulary with primary care? 
  • Who is responsible for keeping the formulary up-to-date in your hospital? 
  • How does a medicine get on to the formulary in your Trust? 
  • Can any pharmacist authorise the supply of a non-formulary medicine for a patient? How is this done in your hospital?

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