At its most basic level, a formulary is a list of medicines.[1] 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, contraindications, 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.
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In the US, where a system of private healthcare is in place, a formulary is a list of prescription drugs 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).[2]
In the UK, the National Health Service (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 Trusts, 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.
A national formulary contains a list of medicines that are approved for prescription 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: