LEC5 Formulary PDF

The Hospital Formulary PharmD Pharmacy Practice-IVA (Hospital Pharmacy) Dr. Syed Saad Hussain  Content Definition and Purpose Format and preparation Role of Pharmacist Benefits and issues  Backgrou...

The Hospital Formulary PharmD Pharmacy Practice-IVA (Hospital Pharmacy) Dr. Syed Saad Hussain  Content Definition and Purpose Format and preparation Role of Pharmacist Benefits and issues  Background  Concept came into being in 1964 through guiding principles of ASHP Multiplexity of medication Increase in the cost of medications No documented line of communication among healthcare teams  Definition “The hospital formulary is a list of pharmaceutical agents with its important information which reflects the current clinical views of the medical staff.” The hospital formulary system is a method whereby the medical staff of a hospital with the help of pharmacy and therapeutic committee selects and evaluate medical agents and their dosage form which are considered to be most useful in the patient care. The hospital formulary system provides the information for procuring, prescribing, dispensing and administering of drugs  Definition A formulary is a list of drugs approved for use in a given setting, such as within: – Hospitals and Health Systems – Employer Groups – Government agencies (Medicaid, VA system) Dictates prescription drug/class coverage and/or the level of coverage (i.e. patient copayment) The system is the basis of appropriate, economical drug therapy  Purpose The creation and continuous evaluation of a hospital’s formulary facilitates – Superior patient care, – Achieves therapeutic goals, – Improves patient safety – Curtails expenses  Objectives Information of drug products that are approved by P&TC Basic therapeutic information Information on hospital policies and procedures governing the use of drugs Special information – Hospital approved abbreviations – Sodium contents etc,  Development of the Formulary The formulary generally: Offers one or more therapeutic options per disease category Facilitates purchasing and prescribing Helps manage cost by reducing duplication Formularies are often used as a negotiating tool with drug manufacturers Drug manufacturers may offer discounts (i.e. rebates) for drugs that are placed on the formulary  Development of the Formulary Content and Organization The formulary generally has three parts: Part One: Information on therapeutic policies Part two: Drug product listings Part three: Special information  Development of the Formulary Content and Organization Part One: Information on therapeutic policies Regulations regarding prescribing, dispensing and administration of drugs – Automatic stop orders – Restricted antibiotic use – Information on the use of formulary – Stat orders, emergency kits – Out prescription policies – Arrangement of non formulary medications – Request of addition of new drugs to formulary  Development of the Formulary Content and Organization Part two: Drug product listings Heart of formulary Contains the list of approved medications/products from P&TC – Generic name – Common synonyms or trade name – Dosage form, strength – Formulation – Identification no (if any)  Development of the Formulary Content and Organization Part three: Special information Can be part of drug product Vary hospital to hospital Contains – Dosage range – Special caution – Controlled or uncontrolled medicine – Monitoring information – Conversion metrics scales or tables  Development of the Formulary Preparation – Prepared by Pharmacist in chief (Director) – Prime responsibility of P&TC (approval) – Selection is based on need of hospital – Type of format Loose leaf or bound – Open or closed formulary – Policies on prescribing – Procedure of dispensing medications  Development of the Formulary Selection of medicines 1. Proven efficacy and use in the healthcare setting 2. Drug should be recognized by national formulary 3. Manufacturer should be one with proven integrity and dependability as well capable of conducting research 4. No secret composition preparation is allowed to be included in formulary 5. Multiple medications with similar therapeutic efficacy should be incorporated 6. Products with multiple composition  Development of the Formulary Format and Appearance Physical appearance and structure influence its use Should be visually pleasing, easily readable and professional Can be made attractive by – Different color page used for different sections – Using edge index – Making pocket size – Standout letter formatting  Development of the Formulary Format and Appearance Minimum composition – Title page – Names and title of P&TC committee – Table of contents – Information on hospital policies and procedures on drug use – Products approved for use in health care facility  Development of the Formulary Additional Considerations Outcomes-Based Agreements/Contracts Pharmacogenomics and Biopharmaceuticals Biosimilars Lifestyle Drugs Higher Tiers/Multiple Tiers Co-Insurance Health Savings Accounts  Development of the Formulary Distribution Each patient care unit Each division of pharmacy Each member of medical staff HOD of each department should get a personal copy  Potential Demerits Deprive the physician of his right and privilege to prescribe and obtain the brand of his choice: Permits the pharmacist to act as the sole judge of which brands of drugs are to be purchased & dispensed. Can be basis of purchase of inferior medicine and supplies Does not transfer the cost benefit to the patients  Advantages Therapeutic Economic Educational  Therapeutic benefit Most efficient products are listed and available Rationale drug use is promoted Single line of therapeutics is followed through rules and regulations  Economic benefit Eliminates duplication Beneficial for volume purchases Reduces drug expenses  Educational benefit Has prescribing tips Administration education (in case of high alert medications) Additional information regarding pharmacodynamics and pharmacokinetics  Role of Pharmacist Major role in development of formulary Evaluating medications for inclusion in the formulary – Evidence-based evaluation – Pharmacoeconomic assessments – Formulary exceptions  Role of Pharmacist – Cost-Effectiveness Analysis. A method for assessing the gains in health relative to the costs of different health interventions. – Cost Utility Analysis. A comparison of the costs of different procedures with their outcomes measured in “utility based” units—that is, units that relate to a person’s level of well-being and are most often expressed as qu ality adjusted life year  Role of Pharmacist – Generic Substitution. The substitution of drug products that contain the same active ingredient or ingredients and are chemically identical in strength, concentration, dosage form, and route of administration to the drug product prescribed – Medication-Use Evaluation. A systematic and interdisciplinary performance improvement method with an overarching goal of optimizing patient outcomes via ongoing evaluation and improvement of medication utilization  Role of Pharmacist – Therapeutic Alternatives. Drug products with different chemical structures but of the same pharmacologic or therapeutic class and usually have similar therapeutic effects and adverse reaction profiles when administered to patients in therapeutically equivalent doses  Role of Pharmacist Formulary Changes A process to continually update the formulary must be established. Process should include a method for making additions and deletions to the formulary. This process typically involves the submission of a request for formulary addition or deletion from the pharmacy or medical staff. This request may be written or verbal. Requests generally require specific information. – Agent to be considered for addition or deletion. – Rationale for request. This should include the impact on the cost and quality of patient care. – Alternative agents currently on the formulary Thank you