Medicines formularies: And your point is?

Search the internet for ‘hospital drug formularies’; the return is an extensive list from healthcare organisations with a number listed as joint formulary publications for the local healthcare economy. The purpose of the formulary is to promote evidence based, safe, clinically effective and cost-effective prescribing; however, if that is the case, why do all formularies not contain the same medicines for treating the same conditions? Does this mean that, instead of increasing rational prescribing, formularies promote variation? The processes leading to formulary inclusion usually require a consideration of the evidence supporting a medicine’s use and the associated financial consequences. This process is potentially repeated many times over by different local formulary committees which can result in different decisions, leaving significant duplication of effort. The uptake of new medicines within the UK is significantly slower than in healthcare systems in other developed countries. Do formulary processes impede the earlier use of new medicines? What happens when the formularies of primary and secondary care organisations within the same healthcare economy differ? Or the patient sits between two healthcare economies or receives elements of care from different healthcare economies? With the growth of NICE, the emergence of regional medicines optimisation committees, commissioning on a national level and perhaps most important of all patient choice, do formularies still fulfil their original purpose or are they simply lists of medicines which the hospital keeps in stock and the Clinical Commissioning Group is happy to pay for? What are the some of the risks associated with local formularies?