Impact on ability to understand formulary compliance

Introduction

Network members discussed the need to improve compliance and hoped to see a cost reduction in drug spend and better reporting on non-formulary items

What peers in the network found

  • Formularies can act as a barrier and reduce variation

    But this has pro’s and cons. While it forces people to think before prescribing, it could prevent a patient from getting the medication needed or lead to user dissatisfaction with pop-ups and speed of use

  • Formulary is hard to keep up-to-date on electronic systems

    There needs to be strong links between the formulary committee and the ePMA administration team, so formulary changes are immediately reflected on ePMA. Where protocols are used to help guide prescribing, there needs to be a robust process in place to ensure protocols are reviewed to ensure they still reflect the recommended practice and an approval process to ensure only appropriate protocols are added to the system.

  • Identify agreed meaning of formulary terms

    During the build of a system, it is important to identify the agreed meaning of formulary terms to ensure a consistency e.g. 1st line, 2nd line, restricted, reserved, non-formulary etc. The network also recommend having formulary visible at the point of prescribing rather than in a separate system.

  • Find a balance in the number of drug selections available

    Too few options mean more free-text entries, which in turn leads to more errors. However, having too open a selection leads to limited formulary control

  • Build alternatives in to the system

    The maintenance of the formulary needs to cover when a formulary choice is temporarily unavailable and document an alternative in the system. However alternatives need to then be removed when the first choice is available again

  • Involve the formulary team right from the start

    This will allow you to build your catalogue at the beginning with reporting in mind

What to watch out for

  • Mixed understanding among groups involved – such as the difference between the drug ‘database’ content on the system and the more common parlance which is the agreed list of medicines available for use in the organisations. Clarify what you mean by formulary
  • Poor communication: communication with ePMA teams, formulary teams and wider teams to ensure everyone is aware of new additions, deletions and amendments to formulary. However, once the system in embedded the culture will change to realise that the digital system is the key to managing the formulary. Systems and processes are required at the outset and should be part of governance put int place
  • Ensure configuration in the system is governed clearly to avoid confusion. Define a robust process/ guidelines for formulary additions
  • When the formulary is built, it’s important to ensure it is easily amendable (to both be able to make changes or limit changes)
  • Option for Non Formulary medicines to be prescribed generically – both generic and proprietary prescribing should be considered when building the formulary as workarounds may develop to avoid restrictions