Problem 8: Hospital Formulary Decision Flashcards
What is the clinical decision making process to prescribe Glycopyrronium (Seebri breezhaler)?
Glycopyrronium bromide (Seebri Breezhaler) is an inhaled long-acting muscarinic antagonist (LAMA) for maintenance bronchodilator treatment to relieve symptoms in adults with chronic obstructive pulmonary disease (COPD).
Dr Beard has chosen to use a medicine that he is familiar with but has seemingly not explored the options in the existing hospital formulary (other LAMA medications would be available). Online requests to add to a hospital formulary can be found on the intranet of the hospital trust and an application would be made and sent to the local formulary decision committee for review.
What is a formulary?
Aims to provide a list of medicines which are available for prescriber in one specific hospital, reflecting safe, evidence based and cost effective choices.
What are the benefits of a formulary?
Evidence based medicines allowed, cost effective (cost saving tactics for NHS), reviewed and updated monthly
Reviewed and updated monthly
Improving local care pathways
Reduces variations in quality of clinical care
Supports financial management and expenditure
Supports prescribers
Supports the inclusion of patient decisions about their medicines
How is hospital formulary (inc committees, time scale) managed and what are the processes involved with approving new medications onto the hospital formulary?
Reviewed and updated monthly
Local formulary decision making group are the main stakeholders in the decisions / committee
Decisions should include: clinical groups and networks, especially if a formulary decision needs specific knowledge and expertise or has direct implications for a clinical practice area, patients or patient representative groups, local people and communities, relevant manufacturers of medicines, for example, when the company can offer additional evidence and insight that can assist with decision‑making and any other relevant decision‑making groups.
How to access and assimilate information as part of the hospital formulary processes?
NICE appraisals should be consulted
Responding to new evidence and literature in timely a manner - including withdrawal and addition
Responding to
How to respond to this request i.e. how are requests for medicines outside of the formulary dealt with?
See the NICE MPG1 process of developing and updating local formularies?
By the decision making panel (including stake holders, HCPs, other trusts, literature such as NICE appraisal).
Applications to consider a medicine or new indication for inclusion in the local formulary should be submitted by a health professional, although manufacturers may support evidence gathering.
Provide information to the applicant to explain the process for considering a medicine or new indication for inclusion in the local formulary and ensure application forms are readily available. Think about inviting the applicant to a meeting to allow for constructive discussion.
Ensure the following information is included in application forms to consider a medicine or new indications:
details of the health professional making the application, including a declaration of interests
local patient population
details of the medicine, including strength, formulation, therapeutic drug class, indication, monitoring requirements and cost
evidence submission with relevant supporting literature, including efficacy, safety and cost effectiveness
comparison with existing treatments
likely place in therapy
recommendation for the decommissioning of a current formulary medicine, if applicable
resource impact, for example biosimilar medicines.
