Piyush Das, MBBS

Medicare, private HMOs, and Veterans Affairs medical centers justify drug formularies by claiming lower co-payments and insurance premiums and cost-effective health care without diminishing quality. But some physicians believe having to prescribe from a list interferes in medical practice and reduces clinical autonomy.

You may view having to request a consult as a hassle when you wish to prescribe a nonformulary drug. A thoroughly researched nonformulary request can expedite the process, however.

5 strategies for nonformulary requests

1. Reference evidence-based information to support your request.
   
2. Document your patient’s drug trials, dosages, clinical response failure, and adverse effects to expedite review of nonformulary requests.
   
3. Ask the patient about family history of response to a medication. Such pharmacogenetic data may predict response in first-degree relatives and support a nonformulary request.
   
4. Document pharmacokinetic or pharmacodynamic interactions between the formulary drug and other medications the patient is taking.
   
5. List known interactions with foods and diseases.
   

5 tips for practicing within a formulary

Physicians are not alone in being leery of drug formularies. Patients encouraged by direct-to-consumer advertising ask for the newest—and often most expensive medications—may share that wariness.¹ To help us work within the restrictions of a drug formulary system and provide appropriate patient care, we suggest the following helpful strategies:

1. Understand that formularies are well intentioned and highly calculated. Lists are updated frequently to represent physicians’ and other experts’ clinical judgment on the use of safe, appropriate, and cost-effective medications, therapies, and health products that best serve patients.²
   
2. Address patient concerns to help them accept and adhere to prescribed formulary drugs. Emphasize that a medication’s cost does not determine its efficacy.
   
3. Remember that your duty to provide proper treatment supersedes cost considerations.
   
4. Ask for a physician review when your request for a nonformulary drug is denied.
   
5. Use nonpharmacologic treatments such as sleep hygiene, cognitive-behavioral therapy, or relaxation techniques when possible. This approach reduces polypharmacy and keeps costs low.
   

Medicare, private HMOs, and Veterans Affairs medical centers justify drug formularies by claiming lower co-payments and insurance premiums and cost-effective health care without diminishing quality. But some physicians believe having to prescribe from a list interferes in medical practice and reduces clinical autonomy.

You may view having to request a consult as a hassle when you wish to prescribe a nonformulary drug. A thoroughly researched nonformulary request can expedite the process, however.

5 strategies for nonformulary requests

1. Reference evidence-based information to support your request.
   
2. Document your patient’s drug trials, dosages, clinical response failure, and adverse effects to expedite review of nonformulary requests.
   
3. Ask the patient about family history of response to a medication. Such pharmacogenetic data may predict response in first-degree relatives and support a nonformulary request.
   
4. Document pharmacokinetic or pharmacodynamic interactions between the formulary drug and other medications the patient is taking.
   
5. List known interactions with foods and diseases.
   

5 tips for practicing within a formulary

Physicians are not alone in being leery of drug formularies. Patients encouraged by direct-to-consumer advertising ask for the newest—and often most expensive medications—may share that wariness.¹ To help us work within the restrictions of a drug formulary system and provide appropriate patient care, we suggest the following helpful strategies:

1. Understand that formularies are well intentioned and highly calculated. Lists are updated frequently to represent physicians’ and other experts’ clinical judgment on the use of safe, appropriate, and cost-effective medications, therapies, and health products that best serve patients.²
   
2. Address patient concerns to help them accept and adhere to prescribed formulary drugs. Emphasize that a medication’s cost does not determine its efficacy.
   
3. Remember that your duty to provide proper treatment supersedes cost considerations.
   
4. Ask for a physician review when your request for a nonformulary drug is denied.
   
5. Use nonpharmacologic treatments such as sleep hygiene, cognitive-behavioral therapy, or relaxation techniques when possible. This approach reduces polypharmacy and keeps costs low.
   

Medicare, private HMOs, and Veterans Affairs medical centers justify drug formularies by claiming lower co-payments and insurance premiums and cost-effective health care without diminishing quality. But some physicians believe having to prescribe from a list interferes in medical practice and reduces clinical autonomy.

You may view having to request a consult as a hassle when you wish to prescribe a nonformulary drug. A thoroughly researched nonformulary request can expedite the process, however.

5 strategies for nonformulary requests

1. Reference evidence-based information to support your request.
   
2. Document your patient’s drug trials, dosages, clinical response failure, and adverse effects to expedite review of nonformulary requests.
   
3. Ask the patient about family history of response to a medication. Such pharmacogenetic data may predict response in first-degree relatives and support a nonformulary request.
   
4. Document pharmacokinetic or pharmacodynamic interactions between the formulary drug and other medications the patient is taking.
   
5. List known interactions with foods and diseases.
   

5 tips for practicing within a formulary

Physicians are not alone in being leery of drug formularies. Patients encouraged by direct-to-consumer advertising ask for the newest—and often most expensive medications—may share that wariness.¹ To help us work within the restrictions of a drug formulary system and provide appropriate patient care, we suggest the following helpful strategies:

1. Understand that formularies are well intentioned and highly calculated. Lists are updated frequently to represent physicians’ and other experts’ clinical judgment on the use of safe, appropriate, and cost-effective medications, therapies, and health products that best serve patients.²
   
2. Address patient concerns to help them accept and adhere to prescribed formulary drugs. Emphasize that a medication’s cost does not determine its efficacy.
   
3. Remember that your duty to provide proper treatment supersedes cost considerations.
   
4. Ask for a physician review when your request for a nonformulary drug is denied.
   
5. Use nonpharmacologic treatments such as sleep hygiene, cognitive-behavioral therapy, or relaxation techniques when possible. This approach reduces polypharmacy and keeps costs low.