The Hospital Formulary has been in effect a UAMS since 1959. The purpose of this system is to provide a professional review of all drugs stocked for use in the hospital.

When available, generic products of brand name items will be dispensed based on generic equivalency and bioavailability of accordance with Federal Standards. Substandard products due to formulation, manufacturing procedures, storage, or any other reason will not be tolerated.

In the interest of efficient and cost effective patient care, the UAMS Pharmacy & Therapeutics (P&T) Committee has developed specific pathways with regard to management of the formulary. Specifically, the addition of drugs to the formulary, the review of drugs within a therapeutic class to determine the role of each agent on the formulary, and the review of drugs within a therapeutic class to determine therapeutic interchange alternatives will be performed using the procedures outlined in this policy.

To promote patient safety, the P&T Committee will evaluate and limit available dosage forms, similar drug therapies, similar drug names and/or appearance and available drug concentrations.  This will be accomplished by the formulary process and electronic medical record medication order entry approval.

The Formulary is a listing of drugs, dosage forms, drugs strengths, and in some cases package sizes stocked by the Inpatient and Outpatient pharmacies. It is available for reference on the Pharmacy Web site and is updated monthly after each P&T Committee meeting. All formulary items are listed in the electronic medical record pharmacy drug file.

The formulary is divided into five general parts: General Pharmacy Information; Therapeutic Class Index: Drug Monographs; Guidelines for Use; and Appendix containing General Reference Material.

1. Therapeutic Class Index

The Therapeutic Class Index is a listing of the formulary drugs by AHFS (American Hospital Formulary Service) category. From the Therapeutic Class Index, physicians can determine if a particular drug is stocked in any form. If it is, the physician can then refer to the Drug Monographs section for more complete information.

2. Drug Monographs

The Drug Monograph section is an alphabetical listing of the formulary drugs by both the trade and generic names. The trade name will refer to the generic name under which the complete information will be found. Each monograph will contain the following information:

1. Official, non-proprietary, or generic name
2. Trade name (The listing of a trade name does not necessarily mean that it is the product stocked in the pharmacy)
3. AHFS Category (useful for cross-reference to the Therapeutic Class Index)
4. Dosage forms available from the pharmacy
5. Special notes (i.e. restrictions, unusual circumstances in which the drug is used)

• Due to the nature of some formulary items, Guidelines for Use of these agents at UAMS have been developed and approved by the P&T committee. These listings describe the appropriate and inappropriate uses of the specific agents and also aid the physician in the dosing, monitoring and expected outcomes from these drugs.

The formulary system is managed by the Pharmacy and Therapeutics (P&T) Committee. The committee is established by the Medical Board, and membership is comprised of representatives of the professional departments/services, nursing, pharmacy, administration, College of Pharmacy, and other interested parties.

The committee shall be responsible for the development and surveillance of all drug utilization policies and practices, including guidelines for use, in order to assure optimal clinical results and a minimum potential for hazard, all in a cost-effective manner. The committee shall assist in the formulation of broad professional policies regarding the evaluation, appraisal, selection, procurement, storage, distribution, use, safety and all other matters relating to drugs and medication use in the hospital.

D. PROCEDURES

1. Addition of New Drugs

1. When a drug is requested for addition to the formulary, the requesting physician or other medical personnel will complete Section I of the "Request for Addition of a Drug to the Formulary" and return the form to the Pharmacy Department.
2. The Pharmacy Department will complete Section II of the same form and return it to the requester.
3. The requester will then complete Section III and forward to his/her department chairperson for approval. If approved, the department chairperson will return the form to the pharmacy department.
4. The request will then be forwarded to the Pharmacy & Therapeutics Committee for consideration.
5. The P&T Committee maintains the authority to review and add drugs(s) to the formulary without a formal request from a healthcare professional.
6. The P & T Committee will review each request and determine if the medication will be available for dispensing or administration based upon the following criteria:  indication for usage, available efficacy data or information, adverse effects, drug interactions, possibility of medication errors including look-alike sound-alike drugs, abuse potential, and cost analysis.

Medications evaluated by the P & T Committee for dispensing or administration will be classified: 1) Accepted for formulary 2)Accepted and restricted  3)Denied for formulary but stocked or 4)Denied for formulary.

If the committee has a safety or financial concern about the use of a drug, Guidelines for Use will be requested and/or adopted before the drug is made available for general formulary use.

2. Review of Formulary Additions

1. The P & T Committee will designate an appropriate time frame for review of any drug added to the formulary that has a narrow therapeutic index, an anticipated potential for inappropriate use, and/or is a financial concern.
2. Annually, the P & T  Committee will evaluate any drug available for dispensing or administration for continued therapeutic value and usage.

   3.    Review of Therapeutic Drug Classes

1.  A systematic approach is used when the Department of Pharmacy or other medical personnel wish to review a therapeutic drug class for the determination of the role of each agent either currently on the formulary or not.

   4.  Review of Drugs for Therapeutic Interchange

1. A systematic approach is used when the Department of Pharmacy or other medical personnel wish to review drugs within a therapeutic class to determine the possibility of therapeutic interchange between the agents.
2. If a drug class is designated for therapeutic interchange, all patients receiving that particular therapy will receive the drug designated for therapeutic interchange unless there is a clinical reason to change.
3. All changes of drugs in therapeutic interchange will be publicized to the medical staff before implementation, and all prescriptions will be filled according to P & T Committee guidelines.