Developing a Formulary

As defined by the American Society of Health-System Pharmacists (ASHP), a drug formulary is a continually updated list of medications and related information, which represents the clinical judgment of physicians, pharmacists, and other experts for the treatment of disease and promotion of health. In a community setting, a formulary addresses the therapeutic, economic, educational, and rational evidenced-based drug use of the population being served. 

In a community pharmacy, a formulary is a list of medications available at the pharmacy to meet patients’ needs. It can be shared with prescribers explaining medications that are available at the pharmacy and to reduce or restrict the inventory of the pharmacy.

The formulary will likely be comprised of the most commonly used medications to treat chronic conditions such as hypertension, diabetes, hyperlipidemia, asthma, mental health, and others affecting patients across the United States. Medication can be selected from each therapeutic class to help manage chronic conditions based on clinical evidence from nationally supported disease state treatment guidelines and medication monographs (adverse reactions and interactions). See Dispensary of Hope Formulary Development and Utilization. Factors that affect the formulary include availability of medication along with class changes (new drugs that become available, brand to generic switch, and generic to OTC changes), medication shortages, patient allergies and/or adverse events, prescribing changes, guideline changes, adverse effects and alerts, and pharmacoeconomic shifts.

Considerations

  • Start small and with a leaninventory, knowing that pharmacy volume can take a while to build up at first. This reduces waste, staff time, and inventory space. 
  • Set up an inventory by identifying drugs currently dispensed to the uninsuredpatient population, and target these drugs first when ordering. Ordering one of each medication is not recommended as it would require additional shelf space (which may be limited), and these additional drugs may go unused and destroyed. 
  • Share your formularywith prescribers regularly (monthly, quarterly) so they may generate prescribing habits to use what is available through the your “free” vendor inventory first.
    • Site example: Embed the formulary in the EMR, if possible, or print copies of the most recent formulary to share in discharging patient medical records.
  • If getting requests for drugs not available, communicate and educate the prescribers. 
    • First – Share the formulary with them and ask which medications they will likely be needing, then order those. 
    • Second – Ask the prescribers if there are any medications they may need that are not on the formulary. Look for ways to source these if possible. 
    • Third – Keep track of what is available at your pharmacy. Share this available inventory list on a regular basis so prescribers know what is on hand and can be filled.
    • Fourth – Utilize therapeutic interchange to recommend alternative medications to prescribers. For instance, the prescriber asks for fexofenadine and only cetirizine is available at your pharmacy. Recommend a change to cetirizine to prevent the patient going without medication.