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Formulary – why all the problems?

Lets be clear about the definition of a formulary. It is a list of prescribable medicines. Nothing more and nothing less. So why all the fuss. The job is simple – just publish a list of medicines that have been recommended by NICE that are prescribable.

You could just say that any medicine recommended by NICE within either a TAG or a Clinical Guideline will be available to appropriate prescribers in this patch. But that is just not enough. Everyone wants a little more clarity. So here is a simple definition.
If you are a provider, you will need to publish a list of medicines recommended by NICE that can be prescribed in your unit. Obviously it should take account of your scope of practice. A mental health trust does not need to list all the cancer drugs. But a general hospital may need to include everything. The provider may need to include criteria and the payment route, just to make things clear that although a medicine is in the formulary there might be restrictions on its use.
If you are a commissioner, you will need to publish a list of medicines recommended by NICE that are either prescribed or commissioned by your unit – so everything with perhaps the exception of medicines purchased within specialist commissioning contracts – so the NCB will have to demonstrate that their commissioning is compliant. Just for the sake of safety you may need to attach traffic lights showing where the clinical responsibility lies. So most cancer drugs are red and should be managed by a cancer expert for example. Others may be amber and the prescribing responsibility shifts under shared care.

This is the basic requirement. Anything more is additional.

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About markmandc (249 Articles)
A pharmacist with experience working in secondary care, primary care, community pharmacy and general practice.

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