Formulary management in a military treatment facility

In an environment of increased fiscal responsibility and cost constraints, the medical staff must take an active role in deciding how an institution's operating budget is spent. A major expense of a military treatment facility (MTF) is maintaining an adequate and cost-effective formulary. The large number of pharmaceuticals available on the market forces a decision regarding which products to stock. Decision analysis is a technique that helps a medical staff to manage its formulary by listing all of the objective and subjective considerations. The Department of Defense Pharmacoeconomic Center has developed a tri-service formulary to standardize a basic drug list that would be available in each military treatment facility. However, this list cannot be expected to answer all of the factors a medical staff must weigh in developing an MTF-specific formulary. Many considerations must be addressed in these decisions, including the beneficiary population, the potential diagnoses as defined by a database such as the Retrospective Case Mix Analysis System or the Military Health Services System, the institution's mission and defined scope of care, physician interests and specialization, and facility limitations. Military treatment facilities can maintain an appropriate stock of medications that is specific for the scope and practice of a medical staff and work within a budget through careful planning and employment of a decision matrix. This balance of appropriateness and fiscal responsibility allows the maximum range of services within a facility.