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Aformulary is a list ofpharmaceutical drugs, often decided upon by a group of people, for various reasons such as insurance coverage or use at a medical facility.[1] Traditionally, a formulary contained a collection of formulas for thecompounding and testing of medication (a resource closer to what would be referred to as apharmacopoeia today). Today, the main function of a prescription formulary is to specify particular medications that are approved to beprescribed at a particularhospital, in a particularhealth system, or under a particularhealth insurance policy. The development of prescription formularies is based on evaluations of efficacy, safety, andcost-effectiveness of drugs.
Depending on the individual formulary, it may also contain additional clinical information, such asside effects,contraindications, anddoses.
By the turn of the millennium, 156 countries had national or provincialessential medicines lists and 135 countries had national treatment.
In Australia, where there is a public health care system, medications are subsidised under thePharmaceutical Benefits Scheme (PBS) and medications that are available under the PBS and the indications for which they can be obtained under said scheme can be found in at least two places, the PBS webpage[2] and theAustralian Medicines Handbook.[citation needed]
The Prescription Drug List is the national formulary that lists all medical ingredients for human and animal use available with a prescription with the exception of those under theControlled Drugs and Substances Act.[3][4] TheCanadian Agency for Drugs and Technologies in Health (CADTH) is the advisory body that evaluates new medical technologies and prescription medication. Based on recommendations the provincial and territorial governments decide whether or not to implement changes to their healthcare system and public drug formularies.[5] Provincial and territorial government provide partial prescription drug coverage and the overall drug payment is a mix of public taxation, private insurance and out-of-pocket expenses.[4][6] Insurance coverage differs regionally, although each public drug coverage plan must meet standards set by the federal government.[6] Regional health authorities are in charge of regulating and providing its residents insurance while the federal government provides insurance for specifically eligible veterans,First Nations,Inuit, Canadian Forces, federal inmates and some refugees.[4][6]
TheNational Formulary of India (NFI) published by Indian Pharmacopoeia Commission (IPC) is essentially meant for the guidance of the members of the medical and pharmaceutical profession; medical students, nurses and pharmacists etc. working in hospitals, dispensaries and in sales establishments. In the preparation of this Formulary, the expert opinion of medical practitioners, teachers in medicine, nurses, pharmacists etc. has been obtained. The selection of drugs for inclusion in the National Formulary has been made taking into consideration the relative advantages and disadvantages of the various drugs used in current medical practice and their availability in the country. Thus, the National Formulary of India represents a broad consensus of expert opinion in respect of drugs and their formulations and provides the physicians with carefully selected therapeutic agents of proved effectiveness which form the basis of rational drug therapy.
The National Formulary of India is an authoritative guide to prescribing, dispensing and administering medicines for healthcare professionals. It will be useful for framing national drug policies in the country. The Ministry of Health and Family Welfare, Govt. of India vide its notification F. No. X. 11035/2/06-DFQC, dated 8th May 2008 assigned this mandatory responsibility to theIndian Pharmacopoeia Commission, Ghaziabad to publish NFI on regular basis. The First Edition of NFI – National Formulary of India was published in year 1960. The IPC has published three consecutive editions of National Formulary of India since its formation. The Indian Pharmacopoeia Commission has published the 4th edition, 5th edition and 6th edition of NFI.[7] Stakeholders may order the copy of NFI-2021 fromhttps://www.ipc.gov.in/shop/index.php?route=product/category&path=60 . The 7th Edition of National Formulary of India (NFI-2026) is expected to release by early 2026 along with its digital version.
In the US, where a system of quasi-private healthcare is in place, a formulary is a list ofprescription drugs available to enrollees, and a tiered formulary provides financial incentives for patients to select lower-cost drugs. For example, under a 3-tier formulary, the first tier typically includes generic drugs with the lowest cost sharing (e.g., 10% coinsurance), the second includes preferred brand-name drugs with higher cost sharing (e.g., 25%), and the third includes non-preferred brand-name drugs with the highest cost-sharing (e.g., 40%).[8]
When used appropriately, formularies can help manage drug costs imposed on the insurance policy.[8] However, 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 andpremiums. Most formularies cover at least one drug in each drug class, and encouragegeneric substitution (also known as apreferred drug list).[9] Formularies have shown to cause issues in hospitals when patients are discharged when not aligned with outpatient drug insurance plans.[10]
In the UK, theNational Health Service (NHS) providespublicly fundeduniversal health care, financed bynational health insurance. Here, formularies exist to specify which drugs are available on the NHS. The two main reference sources providing this information are theBritish National Formulary (BNF) and theDrug 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. Recommendations for additions to the NHS formulary are provided by theNational Institute for Health and Care Excellence.[11]
In addition to this, localNHS hospital trusts andPrimary Care (General Practitioners)Clinical Commissioning Groups (CCGs), 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, andphysicians may prescribe a non-formulary medicine if they consider it necessary and justifiable. Often, these local formularies are shared between a Primary Care Organisation (PCO) and hospitals within that PCO's jurisdiction, in order to facilitate the procedure of transferring a patient fromprimary care tosecondary care, thus causing fewer "interfacing" issues in the process.
As in the United States, the NHS actively encourages prescribing of generic drugs, in order to save more of the budget allocated to them by theDepartment of Health.
A national formulary contains a list of medicines that are approved forprescription 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:
The National Institute for Health and Care Excellence (NICE) provides recommendations on whether new branded drugs should be covered by the publicly funded NHS.
