Evaluating a restrictive formulary system by assessing nonformulary-drug requests

Area of Science:

• Pharmacy and Therapeutics
• Health Services Research

Background:

• Hospital formulary systems aim to control drug costs and ensure rational drug use.
• Restrictive formularies limit the number of drugs available to prescribers.

Purpose of the Study:

• To evaluate the effectiveness of a restrictive formulary system in a university hospital.
• To compare formulary restrictiveness and non-formulary drug request procedures across similar hospitals.

Main Methods:

• Analysis of non-formulary drug requests over 12 months (January-December 1984).
• Evaluation of request frequency, cost, and physician rationale.
• Telephone survey of eight comparable hospitals regarding their formulary systems.

Main Results:

• 65% of non-formulary requests were for previously denied drugs.
• Potential cost savings of $1887 if formulary alternatives were used.
• Only 13% of non-formulary requests had appropriate rationales (excluding pre-admission therapy).
• Other surveyed hospitals, despite claiming restrictive formularies, had frequent non-formulary requests and procurement procedures.

Conclusions:

• The studied formulary system was restrictive, but its effectiveness was undermined by non-formulary request procedures.
• Strengthening enforcement of formulary restrictions is crucial for realizing benefits from formulary systems.