How to Design a Formulary Maintenance Program with APPE Students

Preceptor Instructions
Learner Level: APPE students preferable; IPPE students with assistance from preceptor
Estimated Time to Complete: The time expectation would be 8-12 hours for each section to be reviewed.  Preceptor Instructions:

  1. Obtain copy of complete formulary. 
  2. Divide formulary by therapeutic drug class (e.g. cardiac, antidiabetics, antibiotics, antiviral, etc.) and subclasses if need be or by American Hospital Formulary Service (AHFS) classification. 
  3. Further divide if the formulary review is to be completed over the span of a year versus one rotation block.
    1. Over the year: Divide the formulary to be divided into 12 sections
    2. Rotation block:  Divide formulary by weeks of rotation (e.g. 6 week rotation would require formulary to be divided in 6 parts)
Precepting Resources

How to Design a Formulary Maintenance Program

Medication Formulary
What is it?
A formulary is a continually updated list of medications and related information, representing the clinical judgment of physicians, pharmacists, and other experts in the diagnosis, prophylaxis, or treatment of disease and promotion of health. A formulary includes, but is not limited to, a list of medications and medication-associated products or devices, medication-use policies, important ancillary drug information, decision-support tools, and organizational guidelines.1

The formulary is generally developed and maintained by the organizations Pharmacy and Therapeutics (P&T) committee.  Medications are brought to formulary for addition, review or deletion through the Medication Use Evaluation process developed by each organization.  They can be brought forward for a variety of reasons including optimization of patient outcomes and safety, medication effectiveness evaluation, standardization of prescribing, dispensing and administration, evaluating medication choice between medications when benefit is unknown, compliance, cost effectiveness, establishing interdisciplinary consensus on medication-use processes and evaluating medications for research purposes.2

Once a facility establishes their medication formulary, they are required to review it on an annual basis by Centers for Medicare and Medicaid (CMS) and The Joint Commission (TJC). It is recommended to break the review up into manageable pieces by reviewing a class (for example, the ASHP Formulary Classifications) as well as reviewing any currently approved therapeutic interchanges each month.
What are the steps to formulary maintenance program?

  1. Identify Medication Classes that need to be reviewed annually.
  2. Organize a schedule for reviewing a class or a few classes each month.
  3. Assign a student to complete the review for each month.
    1. Include in each class review:
      1. Medication Class
      2. Medication Name
      3. Therapeutic interchange Information
      4. Hazardous Medication information
      5. Restrictions
      6. Utilization information
  4. Present to preceptor for approval.
  5. Present to P&T committee.
  6. Implement any formulary changes that resulted from the discussion at the P&T committee.

1. American Society of Health-Systems Pharmacists. ASHP Guidelines on the Pharmacy and Therapeutic Committee and the Formulary System. Am J Health-Syst Pharm. 2008; 65: 1272-83.

2. American Society of Health-System Pharmacists. ASHP guidelines on medication-use evaluation. Am J Health-Syst Pharm. 1996; 53:1953–5.

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