How should you handle non-formulary drugs?

The PTC should select and restrict medication in the formulary. However, there are instances where non-formulary drugs are required. The PTC needs to set policies and guidelines regarding the use of non-formulary drugs. Pharmacists balance the use of non-formulary drugs and maintaining the formulary.

The use of nonformulary agents should be tightly regulated to prevent the erosion of the formulary system. PTC must establish policies for the use and procurement of nonformulary drugs and conduct regular reviews.

Often, non-formulary drug request forms are used to request a nonformulary drug. The form should contain the patient basic information, the rationale of use, the volume of drugs needed. It must also be approved by the authorised personals of the hospital.

Common strategies for managing medication use

• Use generic equivalents
• Therapeutic interchange
• Guided-use policies
• Clinical practice guidelines
• Off-label prescribing
• Medication use evaluation

Using high-quality generic equivalents can provide good patient care and reasonable price. PTC must establish relevant policies such as: The pharmacist is responsible for selecting from available generic equivalents. The prescriber, at the time of prescribing, can specify the brand or supplier of the drug to be dispensed if clinically justified.

Therapeutic alternatives are drugs with different chemical structures but similar therapeutic effects and safety profiles when administered in therapeutically equivalent doses. Pharmacists are authorised to use formulary therapeutic alternatives in place of a nonformulary medication or a non-preferred formulary medication without contacting the prescriber. Different hospitals may have different regulations revolving therapeutic interchange. Either way, adequate educational initiatives should be undertaken to ensure involved healthcare professionals are notified of the therapeutic interchange.

Glossary:

• Generic substitution, substituting prescription with drugs containing similar active ingredients and are chemically identical in strength, concentration, dosage form, and route of administration.
• Therapeutic alternates, drugs with different chemical structures but belongs to the same pharmacological or therapeutic class, with similar therapeutic effects and adverse reaction profiles when administered to patients in therapeutically equivalent doses.
• Therapeutic interchange, authorised exchange of therapeutic alternates in accordance with approved written guidelines or protocols.
• Therapeutic substitution, dispensing a therapeutic alternative for the drug product prescribed without prior authorization of the prescriber. This is illegal because only the prescriber may authorise an exchange of therapeutic alternates.

Share and learn:

When does your hospital use therapeutic alternatives?

What are your hospital’s guidelines on the use of these alternatives?