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A formulary is a list of pharmaceutical 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 the compounding and testing of medication (a resource closer to what would be referred to as a pharmacopoeia today). Today, the main function of a prescription formulary is to specify particular medications that are approved to be prescribed at a particular hospital, in a particular health system, or under a particular health insurance policy. The development of prescription 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.
In Australia, where there is a public health care system, medications are subsidised under the Pharmaceutical 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 the Australian 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 the Controlled Drugs and Substances Act . [3] [4] The Canadian 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]
In the US, where a system of quasi-private healthcare is in place, a formulary is a list of prescription 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%). [7]
When used appropriately, formularies can help manage drug costs imposed on the insurance policy. [7] 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 and premiums. Most formularies cover at least one drug in each drug class, and encourage generic substitution (also known as a preferred drug list). [8] Formularies have shown to cause issues in hospitals when patients are discharged when not aligned with outpatient drug insurance plans. [9]
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. Recommendations for additions to the NHS formulary are provided by the National Institute for Health and Care Excellence. [10]
In addition to this, local NHS hospital trusts and Primary 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, and physicians 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 from primary care to secondary 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 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:
The British National Formulary (BNF) is a United Kingdom (UK) pharmaceutical reference book that contains a wide spectrum of information and advice on prescribing and pharmacology, along with specific facts and details about many medicines available on the UK National Health Service (NHS). Information within the BNF includes indication(s), contraindications, side effects, doses, legal classification, names and prices of available proprietary and generic formulations, and any other notable points. Though it is a national formulary, it nevertheless also includes entries for some medicines which are not available under the NHS, and must be prescribed and/or purchased privately. A symbol clearly denotes such drugs in their entry.
A pharmacist, also known as a chemist in Commonwealth English, is a healthcare professional who specializes in the preparation, dispensing, and management of medications. A pharmacist provides pharmaceutical advice and guidance, often serving as a primary care provider in the community, and offering other services, such as health screenings and immunizations.
Pharmacy is the science and practice of discovering, producing, preparing, dispensing, reviewing and monitoring medications, aiming to ensure the safe, effective, and affordable use of medicines. It is a miscellaneous science as it links health sciences with pharmaceutical sciences and natural sciences. The professional practice is becoming more clinically oriented as most of the drugs are now manufactured by pharmaceutical industries. Based on the setting, pharmacy practice is either classified as community or institutional pharmacy. Providing direct patient care in the community of institutional pharmacies is considered clinical pharmacy.
A prescription, often abbreviated ℞ or Rx, is a formal communication from a physician or other registered healthcare professional to a pharmacist, authorizing them to dispense a specific prescription drug for a specific patient. Historically, it was a physician's instruction to an apothecary listing the materials to be compounded into a treatment—the symbol ℞ comes from the first word of a medieval prescription, Latin recipere, that gave the list of the materials to be compounded.
Prescription drug list prices in the United States continually are among the highest in the world. The high cost of prescription drugs became a major topic of discussion in the 21st century, leading up to the American health care reform debate of 2009, and received renewed attention in 2015. One major reason for high prescription drug prices in the United States relative to other countries is the inability of government-granted monopolies in the American health care sector to use their bargaining power to negotiate lower prices, and the American payer ends up subsidizing the world's R&D spending on drugs.
A prescription drug is a pharmaceutical drug that is permitted to be dispensed only to those with a medical prescription. In contrast, over-the-counter drugs can be obtained without a prescription. The reason for this difference in substance control is the potential scope of misuse, from drug abuse to practicing medicine without a license and without sufficient education. Different jurisdictions have different definitions of what constitutes a prescription drug.
The Pharmaceutical Benefits Scheme (PBS) is a program of the Australian Government that subsidises prescription medication for Australian citizens and permanent residents, as well as international visitors covered by a reciprocal health care agreement. The PBS is separate to the Medicare Benefits Schedule, a list of health care services that can be claimed under Medicare, Australia's universal health care insurance scheme.
The NHS Electronic Prescription Service is part of the NHS National Programme for IT of the National Health Service in England. It enables the electronic transfer of medical prescriptions from doctors to pharmacies and other dispensers and electronic notification to the reimbursement agency, NHS Prescription Services.
BNF for Children (BNFC) is the standard UK paediatric reference for prescribing and pharmacology.
The NHS treatments blacklist is an informal name for a list of medicines and procedures which will not be funded by public money except in exceptional cases. These include but are not limited to procedures which the National Institute for Health and Care Excellence (NICE) has ruled of limited effectiveness and particular brand name medicines. In 2017 there was a proposal for 3,200 over-the-counter (OTC) drugs to be restricted and 18 procedures to be added to the list. This generated some controversy amongst doctors with some arguing that OTC should be blacklisted instead, and others believing the move did not take into account individual patient needs.
Pharmaceutical policy is a branch of health policy that deals with the development, provision and use of medications within a health care system. It embraces drugs, biologics, vaccines and natural health products.
A pharmacy is a premises which provides pharmaceutical drugs, among other products. At the pharmacy, a pharmacist oversees the fulfillment of medical prescriptions and is available to counsel patients about prescription and over-the-counter drugs or about health problems and wellness issues. A typical pharmacy would be in the commercial area of a community.
Medication costs, also known as drug costs are a common health care cost for many people and health care systems. Prescription costs are the costs to the end consumer. Medication costs are influenced by multiple factors such as patents, stakeholder influence, and marketing expenses. A number of countries including Canada, parts of Europe, and Brazil use external reference pricing as a means to compare drug prices and to determine a base price for a particular medication. Other countries use pharmacoeconomics, which looks at the cost/benefit of a product in terms of quality of life, alternative treatments, and cost reduction or avoidance in other parts of the health care system. Structures like the UK's National Institute for Health and Clinical Excellence and to a lesser extent Canada's Common Drug Review evaluate products in this way.
Electronic prescription is the computer-based electronic generation, transmission, and filling of a medical prescription, taking the place of paper and faxed prescriptions. E-prescribing allows a physician, physician assistant, pharmacist, or nurse practitioner to use digital prescription software to electronically transmit a new prescription or renewal authorization to a community or mail-order pharmacy. It outlines the ability to send error-free, accurate, and understandable prescriptions electronically from the healthcare provider to the pharmacy. E-prescribing is meant to reduce the risks associated with traditional prescription script writing. It is also one of the major reasons for the push for electronic medical records. By sharing medical prescription information, e-prescribing seeks to connect the patient's team of healthcare providers to facilitate knowledgeable decision making.
Irish Medicines Formulary (IMF) is a medicines reference for doctors, nurses, pharmacists and dentists, providing medicines information which is medico-legally relevant in Ireland. It is published in online and print formats, and lists original brands, branded generics and pure generic prescription medicines.
Pharmacy in the United Kingdom has been an integral part of the National Health Service since it was established in 1948. Unlike the rest of the NHS, pharmacies are largely privately provided apart from those in hospitals, and even these are now often privately run.
Specialty drugs or specialty pharmaceuticals are a recent designation of pharmaceuticals classified as high-cost, high complexity and/or high touch. Specialty drugs are often biologics—"drugs derived from living cells" that are injectable or infused. They are used to treat complex or rare chronic conditions such as cancer, rheumatoid arthritis, hemophilia, H.I.V. psoriasis, inflammatory bowel disease and hepatitis C. In 1990 there were 10 specialty drugs on the market, around five years later nearly 30, by 2008 200, and by 2015 300.
Separation of prescribing and dispensing, also called dispensing separation, is a practice in medicine and pharmacy in which the physician who provides a medical prescription is independent from the pharmacist who provides the prescription drug.
The Top 100 Drugs: Clinical Pharmacology and Practical Prescribing is a pocket-size medical manual focusing on the most commonly prescribed medicines by the British National Health Service (NHS). It was first published by Churchill Livingstone, Elsevier, in 2014, revised in a second edition in 2018, and again in 2022 in a third edition. It is authored by four clinical pharmacologists from St George's Hospital, London; Andrew Hitchings, Dagan Lonsdale, Daniel Burrage and Emma Baker.
The National Institute for Health and Care Excellence (NICE) provides recommendations on whether new branded drugs should be covered by the publicly funded NHS.