Formulary (pharmacy)
Encyclopedia
At its most basic level, a formulary is a list of medicines. 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). The main function of formularies today is to specify which medicines are approved to be prescribed
under a particular contract. The development of 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
, contraindication
s, 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.
is in place, a formulary is a list of prescription drug
s covered by a particular drug benefit plan.
Patients pay varying co-pays
for drugs that are on formulary. 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).
(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 Trust
s, including Hospital Trusts
and Primary Care Trusts
(PCTs), 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 PCT and hospitals within that PCT'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, NHS trusts actively encourage generic
prescribing, in order to save more of the budget allocated to them by their Strategic Health Authority
, and ultimately, the Department of Health
.
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:
Compounding
Compounding is the mixing of drugs by a compounding pharmacist to fit the unique needs of a patient...
and testing of medication (a resource closer to what would be referred to as a pharmacopoeia
Pharmacopoeia
Pharmacopoeia, pharmacopeia, or pharmacopoea, , in its modern technical sense, is a book containing directions for the identification of samples and the preparation of compound medicines, and published by the authority of a government or a medical or pharmaceutical society.In a broader sense it is...
today). The main function of formularies today is to specify which medicines are approved to be prescribed
Medical prescription
A prescription is a health-care program implemented by a physician or other medical practitioner in the form of instructions that govern the plan of care for an individual patient. Prescriptions may include orders to be performed by a patient, caretaker, nurse, pharmacist or other therapist....
under a particular contract. The development of 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
Adverse effect
In medicine, an adverse effect is a harmful and undesired effect resulting from a medication or other intervention such as surgery.An adverse effect may be termed a "side effect", when judged to be secondary to a main or therapeutic effect. If it results from an unsuitable or incorrect dosage or...
, contraindication
Contraindication
In medicine, a contraindication is a condition or factor that serves as a reason to withhold a certain medical treatment.Some contraindications are absolute, meaning that there are no reasonable circumstances for undertaking a course of action...
s, and doses
Dose (biochemistry)
A dose is a quantity of something that may impact an organism biologically; the greater the quantity, the larger the dose. In nutrition, the term is usually applied to how much of a specific nutrient is in a person's diet or in a particular food, meal, or dietary supplement...
.
By the turn of the millennium, 156 countries had national or provincial essential medicines
Essential medicines
Essential medicines, as defined by the World Health Organization are "those drugs that satisfy the health care needs of the majority of the population; they should therefore be available at all times in adequate amounts and in appropriate dosage forms, at a price the community can afford."The WHO...
lists and 135 countries had national treatment guidelines and/or formulary manuals.
United States
In the US, where a system of private healthcarePrivate healthcare
Private healthcare or private medicine is healthcare and medicine provided by entities other than the government. The term is generally used more in Europe and other countries which have publicly-funded health care, to differentiate the arrangement from the usual system.Ethical issues relating to...
is in place, a formulary is a list of prescription drug
Prescription drug
A prescription medication is a licensed medicine that is regulated by legislation to require a medical prescription before it can be obtained. The term is used to distinguish it from over-the-counter drugs which can be obtained without a prescription...
s covered by a particular drug benefit plan.
Patients pay varying co-pays
Copayment
In the United States, the copayment or copay is a payment defined in the insurance policy and paid by the insured person each time a medical service is accessed. It is technically a form of coinsurance, but is defined differently in health insurance where a coinsurance is a percentage payment after...
for drugs that are on formulary. 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
Generic drug
A generic drug is a drug defined as "a drug product that is comparable to brand/reference listed drug product in dosage form, strength, route of administration, quality and performance characteristics, and intended use." It has also been defined as a term referring to any drug marketed under its...
substitution (also known as a preferred drug list).
United Kingdom
In the UK, the National Health ServiceNational Health Service
The National Health Service is the shared name of three of the four publicly funded healthcare systems in the United Kingdom. They provide a comprehensive range of health services, the vast majority of which are free at the point of use to residents of the United Kingdom...
(NHS) provides publicly-funded
Publicly-funded health care
Publicly funded health care is a form of health care financing designed to meet the cost of all or most health care needs from a publicly managed fund. Usually this is under some form of democratic accountability, the right of access to which are set down in rules applying to the whole population...
universal health care
Universal health care
Universal health care is a term referring to organized health care systems built around the principle of universal coverage for all members of society, combining mechanisms for health financing and service provision.-History:...
, financed by national health insurance
National health insurance
National health insurance is health insurance that insures a national population for the costs of health care and usually is instituted as a program of healthcare reform. It is enforced by law. It may be administered by the public sector, the private sector, or a combination of both...
. 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
British National Formulary
The British National Formulary is a medical and pharmaceutical reference book that contains a wide spectrum of information and advice on prescribing and pharmacology, along with specific facts and details about all medicines available on the National Health Service , including indication,...
(BNF) and the Drug Tariff
Drug Tariff
The Drug Tariff is a monthly UK publication used as a reference for the payment and repayment of NHS prescription costs in the UK by pharmacists or doctors dispensing in primary care. It covers such issues as the costs of prescription payments for patients, costs of appliances and blacklisted...
. There is a section in the Drug Tariff, known unofficially as the “Blacklist
Blacklisted (medicine)
In the National Health Service in the United Kingdom, the Blacklist is a list published in Part XVIIIA of the NHS Drug Tariff denoting medicines and/or specific brands of medicines that cannot be prescribed on NHS medical prescriptions...
”, detailing medicines which are not to be prescribed under the NHS and must be paid for privately
Private healthcare
Private healthcare or private medicine is healthcare and medicine provided by entities other than the government. The term is generally used more in Europe and other countries which have publicly-funded health care, to differentiate the arrangement from the usual system.Ethical issues relating to...
by the patient.
In addition to this, local NHS Trust
NHS Trust
A National Health Service trust provides services on behalf of the National Health Service in England and NHS Wales.The trusts are not trusts in the legal sense but are in effect public sector corporations. Each trust is headed by a board consisting of executive and non-executive directors, and is...
s, including Hospital Trusts
NHS Hospital Trust
An NHS hospital trust, also known as an acute trust is an NHS trust that provides secondary health services within the English National Health Service and in NHS Wales. Hospital trusts are commissioned to provide these services by NHS primary care trusts....
and Primary Care Trusts
NHS Primary Care Trust
An NHS primary care trust is a type of NHS trust, part of the National Health Service in England. PCTs commission primary, community and secondary care from providers. Until 31 may2011 they also provided community services directly. Collectively PCT are responsible for spending around 80% of the...
(PCTs), 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 PCT and hospitals within that PCT's jurisdiction, in order to facilitate the procedure of transferring a patient from primary care
Primary care
Primary care is the term for the health services by providers who act as the principal point of consultation for patients within a health care system...
to secondary care, thus causing fewer “interfacing” issues in the process.
As in the United States, NHS trusts actively encourage generic
Generic drug
A generic drug is a drug defined as "a drug product that is comparable to brand/reference listed drug product in dosage form, strength, route of administration, quality and performance characteristics, and intended use." It has also been defined as a term referring to any drug marketed under its...
prescribing, in order to save more of the budget allocated to them by their Strategic Health Authority
NHS Strategic Health Authority
NHS strategic health authorities are part of the structure of the National Health Service in England. Each SHA is responsible for enacting the directives and implementing fiscal policy as dictated by the Department of Health at a regional level. In turn each SHA area contains various NHS trusts...
, and ultimately, the Department of Health
Department of Health (United Kingdom)
The Department of Health is a department of the United Kingdom government with responsibility for government policy for health and social care matters and for the National Health Service in England along with a few elements of the same matters which are not otherwise devolved to the Scottish,...
.
National formulary
A national formulary contains a list of medicines that are approved for prescriptionMedical prescription
A prescription is a health-care program implemented by a physician or other medical practitioner in the form of instructions that govern the plan of care for an individual patient. Prescriptions may include orders to be performed by a patient, caretaker, nurse, pharmacist or other therapist....
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:
- Australian Pharmaceutical Formulary
- British National FormularyBritish National FormularyThe British National Formulary is a medical and pharmaceutical reference book that contains a wide spectrum of information and advice on prescribing and pharmacology, along with specific facts and details about all medicines available on the National Health Service , including indication,...
- British National Formulary for ChildrenBritish National Formulary for ChildrenThe British National Formulary for Children is the standard UK paediatric reference for prescribing and pharmacology, among others indications, side effects and costs of the prescription of all medication drugs available on the National Health Service....
- Sri LankaSri LankaSri Lanka, officially the Democratic Socialist Republic of Sri Lanka is a country off the southern coast of the Indian subcontinent. Known until 1972 as Ceylon , Sri Lanka is an island surrounded by the Indian Ocean, the Gulf of Mannar and the Palk Strait, and lies in the vicinity of India and the...
n Formulary - United States National Formulary, since bought out and merged with the United States PharmacopeiaUnited States PharmacopeiaThe United States Pharmacopeia is the official pharmacopeia of the United States, published dually with the National Formulary as the USP-NF. The United States Pharmacopeial Convention is the nonprofit organization that owns the trademark and copyright to the USP-NF and publishes it every year...
FASS is the SwedishSwedenSweden , officially the Kingdom of Sweden , is a Nordic country on the Scandinavian Peninsula in Northern Europe. Sweden borders with Norway and Finland and is connected to Denmark by a bridge-tunnel across the Öresund....
national formulary, the abbreviation standing for Farmaceutiska Specialiteter i Sverige. Usage of the database is free of charge and it has no promotional texts or advertising. Fass has been developed by the Swedish Association of the Pharmaceutical Industry (LIF) in close cooperation with Sweden’s pharmaceutical industry, with additional assistance from the Medical Products AgencyMedical Products AgencyThe Medical Products Agency is the Swedish national authority responsible for regulation and surveillance of the development, manufacturing and sale of medicinal drugs, medical devices and cosmetics....
, the Pharmaceutical Benefits Board and the National Corporation of Pharmacies. Information on interactions is derived from a joint development between the Departmentof Pharmaceutical Biosciences at Uppsala University and the Swedish Association of the Pharmaceutical Industry (LIF).
See also
- PharmacopoeiaPharmacopoeiaPharmacopoeia, pharmacopeia, or pharmacopoea, , in its modern technical sense, is a book containing directions for the identification of samples and the preparation of compound medicines, and published by the authority of a government or a medical or pharmaceutical society.In a broader sense it is...
- Chilean pharmaceutical policyChilean pharmaceutical policyThe Chilean Pharmaceutical Policy was an attempt in the 1960s and 1970s to introduce a rational national pharmaceuticals policy. Chile was perhaps the first country in the world to introduce the concept of a limited number of essential drugs....
- Medicare Part DMedicare Part DMedicare Part D is a federal program to subsidize the costs of prescription drugs for Medicare beneficiaries in the United States. It was enacted as part of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 and went into effect on January 1, 2006.- Eligibility and...
- Medicare Prescription Drug, Improvement, and Modernization ActMedicare Prescription Drug, Improvement, and Modernization ActThe Medicare Prescription Drug, Improvement, and Modernization Act is a federal law of the United States, enacted in 2003. It produced the largest overhaul of Medicare in the public health program's 38-year history.The MMA was signed by President George W...
- Prescription drug prices in the United StatesPrescription drug prices in the United StatesPrescription drug prices in the United States are the highest in the world. "The prices Americans pay for prescription drugs, which are far higher than those paid by citizens of any other developed country, help explain why the pharmaceutical industry is — and has been for years — the most...
- Seneka BibileSeneka BibileSenaka Bibile was a Sri Lankan pharmacologist. He was the founder of Sri Lanka’s drug policy, which was used as a model for development of policies based on rational pharmaceutical use in other countries as well by the World Health Organization, the United Nations Conference on Trade and...
- Specification (technical standard)Specification (technical standard)A specification is an explicit set of requirements to be satisfied by a material, product, or service. Should a material, product or service fail to meet one or more of the applicable specifications, it may be referred to as being out of specification;the abbreviation OOS may also be used...
- Sri Lanka National Pharmaceuticals PolicySri Lanka National Pharmaceuticals PolicyThe Sri Lanka National Pharmaceuticals Policy was established in the 1970s following the submission of a report by Dr S.A. Wickremasinghe and Prof. Seneka Bibile. It aimed at ensuring that people get good quality drugs at the lowest possible price and that doctors would prescribe the minimum...
- State Pharmaceuticals Corporation of Sri LankaState Pharmaceuticals Corporation of Sri LankaThe State Pharmaceuticals Corporation is a state-owned enterprise with its headquarters in Colombo, Sri Lanka. It is the largest supplier of drugs in the country, and is tasked with providing quality-assured health care items that are safe and effective, at an affordable price, while educating the...
- National Drug Code SystemNational Drug Code SystemThe National Drug Code System is a system that is designed to provide drugs in the United States with a specific 11-digit number that describes the product...