Positive Lists (Formularies) 2024/2025 PDF

PharmDr. Tereza Toušková, PhD. POSITIVE LISTS (FORMULARIES) Deparment of social and clinical pharmacy 2024/2025 DEFINITION OF FORMULARY/POSITIVE LIST The term positive list/formulary of medicines has two meanings: (a)A list of medicin...

PharmDr. Tereza Toušková, PhD. POSITIVE LISTS (FORMULARIES) Deparment of social and clinical pharmacy 2024/2025 DEFINITION OF FORMULARY/POSITIVE LIST The term positive list/formulary of medicines has two meanings: (a)A list of medicines that are covered by insurance companies in a given country. (b)A continuously updated list of medicinal products that are in a given health facility or in the community of outpatient practitioners, as their use is preferable for various reasons (e.g. their cost, the existence of evidence in EBM). WHAT IS THE FORMULARY? A drug formulary, or preferred drug list, is a continually updated list of medications and related products supported by current evidence-based medicine, judgment of physicians, pharmacists and other experts in the diagnosis and treatment of disease and preservation of health. The primary purpose of the formulary is to encourage the use of safe, effective and most affordable medications. A formulary system is much more than a list of medications approved for use by a managed health care organization. Formulary systems often contain additional prescribing guidelines and clinical information which assist health care professionals to promote high quality, affordable care for patients. HISTORY OF FORMULARIES In the 1980s in the Netherlands - doctors made prescription errors due to low knowledge of medicines. It was found that if a doctor had to prescribe a medicine for a patient with a certain diagnosis, he could only recall 2-5 medicines that he could use. He remembers a total of 150-200 names of medicines. In the Netherlands, doctors in collaboration with pharmacists started to compile lists of medicines to serve as a guide when prescribing medicines to avoid duplication and to help inform medicines. These organisations then spread to other countries, such as the UK, Sweden and other Nordic countries. FORMULARY MANAGEMENT: EFFECTS OF STANDARDIZED VS NON-STANDARDIZED  WHY ARE FORMULARIES USED? Reduction of Costs Improving quality of care  By limiting the number of substances used, frequent medication errors are avoided  The quality of care is further enhanced if the choice of drugs is based on EBM. Improved availability of requested medicines TYPES OF FORMULARIES 1) Forms of hospital formularies 2) Outpatients formularies 3) Open, partially-closed and closed formularies 4) List of essential medicines, national lists 5) Lists of medicines created by insurance companies  HOSPITAL FORMULARIES List by ATC groups and generic names. They also include company names. They are listed in alphabetical order at the end. Medicines are selected by a team of doctors and pharmacists. No or minimal co-payments. Available from the hospital pharmacy. Guide physicians and pharmacists as to which of the medicinal substances available on the. An ATC code is assigned to each medicinal product, which allows the medicinal product to be assigned back to a specific therapeutic group. OUTPATIENTS FORMULARIES Through the prescription of cheaper generic products, it leads to a reduction in the cost of prescription drugs for insurance companies. The outpatient positive list brings savings, among other things, to patients because they are prescribed medicines with lower co-payments. Another advantage of the outpatient positive list is that, as with the hospitalbetter orientation of prescribers to medicines, which leads to the elimination ofprescribing errors. OPEN X PARTIALLY CLOSED X CLOSED FORMULARIES LIST OF ESSENTIAL MEDICINES, NATIONAL LISTS Essential medicines are selected by the World Health Organization with regard to prevalence of diseases, evidence of efficacy and safety, and cost effectiveness. Usually made up of generic names, which are grouped into therapeutic groups Some European countries have a national list e.g. Sweden and England If a country has a national list of essential medicines, then the hospital positive lists should be based on these. LISTS OF MEDICINES CREATED BY INSURANCE COMPANIES In the Czech Republic, medicinal products used in hospital care are fully reimbursed under the Public Health Insurance Act (the least costly option), even if the reimbursement has not been determined by SÚKL.  THE SYSTEM OF ORGANISATION AND MANAGEMENT OF THE FORMULARY The drug committee The expert committee The institutional pharmacy The antibiotic centre HOSPITAL FORMULARIES DEFINITION 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 provides the information for procuring, prescribing, dispencing and administrative of drug under non proprietary names and instance where drugs have both names. HOSPITAL FORMULARIES It provides information for: Procuring Prescribing Dispensing Administration of drugs under brand names where the drug have both names.  ADVANTAGES OF HOSPITAL FORMULARY 1. Cost Control: Budget Management 4. Streamlined Decision-Making Simplified Drug Selection Generic Substitution Quick Access to Information 2. Quality Assurance 5.Optimized Patient Outcomes Standardized Treatment Evidence-Based Selection Protocols Consistent Care: Therapeutic Guidelines 6. Efficient Resource Utilization: Inventory Management 3. Patient Safety Formulary Review Committees Reduced Medication Errors Drug Interaction Monitoring ADVANTAGES OF HOSPITAL FORMULARY It is very handy for use by the physician and nursing staff. It helps physicians to know about the available drugs in the hospital pharmacy and also helps in better inventory control. Evidence based treatment guidelines. It is complete, concise, updated and easy to use. Improves clinical practice of health care professionals. Reduces the variation in the level of treatment provided to the patients and controlling drug cost. DISADVANTAGES OF HOSPITAL FORMULARY 1. Limited treatment options – restricted choices 2. Access and equity concerns - patient variability and acess issues 3. Cost-containment pressures – focus on cost savings 4. Clinical rigidity – lack of flexibility 5. Physicians frustration 6. Administrative burden – formulary management 7. Patient compliance issues 8. Supply chain risks 9. Influence of pharmaceutical industry FORMULARY DEVELOPMENT PROCEDURE FOR COMPILING A POSITIVE LIST 1. Compilation of the list of active substances 2. Medicinal products shall be assigned to medicinal substances 3. Implementation of the finished positive list 4. Create a manual for the use of the positive list 5. Updating the positive list  PHARMACY FORMULARIES Pharmacy Positive List: Pharmacies have a list of preferred medicines, often from a single company with which they have a contract. Benefits of Preferred Purchasing: By buying more from one company, they receive better prices. Pressure for Substitution: Pharmacists, especially in chain pharmacies, are encouraged to substitute prescribed medicines with those on the positive list. Financial Incentives: Following the list rewards pharmacists financially; not following it may result in losing points. Competition Among Pharmacies: Chain pharmacies compete with each other, and entire teams of pharmacists are held to certain standards. Primary Goal: Economic profit.  HEALTH ETHICS Law and Ethics for Pharmacists (Department of Social and Clinical Pharmacy | Intranet FAF) Pharmaceutical care I (lecture Ethic issues in pharmacy)