A National Survey on Hospital Formulary Management Processes

Purpose: In light of formulary management guidelines from the American Society of Health-System Pharmacists (ASHP), and discussion of pharmacies' noncompliance with recent Joint Commission accreditation requirements, the University HealthSystem Consortium conducted a formulary management survey to determine member institutions' standard of practice. Methods: An electronic survey was distributed to 227 institutions. Questions pertained to formulary structure, policies and procedures to manage formulary processes, tracking nonformulary medication use, pharmacoeconomic assessment, and Food and Drug Administration (FDA)-approved versus off-label medication use. Results: Fifty-two institutions across the United States provided responses. Most institutions maintain written policies for how medications are requested (94%) and reviewed (88%) for formulary addition; 92% of institutions have a nonformulary medication process. Nonformulary medication use is tracked at 88% of institutions, and 85% of institutions conduct pharmacoeconomic analyses. Regarding The Joint Commission’s requirement to approve drugs for specific indications, 40% of institutions approve drugs for all FDA-approved indications; 35% of institutions have not formally addressed this requirement. Approximately 31% of the institutions have a policy for approving a medication for an off-label indication. Conclusion: Portions of the ASHP guidelines have been implemented by most institutions, while 35% of institutions have yet to address The Joint Commission’s clarification to approve drugs for specific indications.