Formulary systems drug selection

Some individuals have advocated that pharmacists be granted independent prescriptive authority—that is, authority to prescribe medications independent of a defined collaborative relationship with an individual physician or medical group. Indeed, the system operative in Florida represents a form of independent prescriptive authority for pharmacists, albeit limited to a select formulary of drugs. Others have argued that pharmacists should function in a dependent role where prescriptive authority is delegated by a physician or other independent prescriber to another health care professional whom that prescriber believes possesses the professional skills and judgment necessary to perform these delegated duties. 

Formulary system management falls into three general categories drug selection for formulary inclusion, formulary maintenance, and medication use evaluation. 

A stand-alone outpatient drug benefit manager might only worry about the drug cost for the nonhospitalized portion of the therapy. The overall health system may be at financial risk for all elements of outpatient and inpatient care. Because each element of the system may be responsible for a different component of the total cost of care, the cost-impact of a given drug product selection may be different for each element. The societal perspective" often represents yet another view of drug costs in that it incorporates nonhealthcare costs and the value of lost days of work and disability. Formulary inclusion is not routinely based on that level of evaluation, but public policy may be influenced by that information. 

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