The formulary process is the cornerstone of good pharmaceutical management and rational drug use. It consists of preparing, using and updating a formulary list (essential medicines list, EML, or essential drugs list, EDL), a formulary manual (providing information on drugs in the formulary list) and standard treatment guidelines (STGs). Choosing the most appropriate therapies and selecting the most cost-effective good-quality drugs leads to better quality of care and more efficient, equitable use of resources.
Strict adherence to a formulary list alone will not improve treatment practice if drug selection is not based on STGs (i.e. if there is no consistency between the formulary list and the STGs). Furthermore, essential medicines can also be used inappropriately if there are no guidelines for disease management. Ideally, a formulary list should be developed after the appropriate treatment guidelines for common diseases have been identified or developed. In many countries, there are already national STGs and other texts on standard treatment protocols that can be followed and used as a starting point when developing a hospital formulary list or local STGs. Once a formulary list is established, a formulary manual, containing information on all the medicines in the formulary list, can be developed. Figure 3.1 shows the relationship between STGs and EMLs and how these affect respectively the use and the availability of medicines.
Figure 3.1 How STGs and EMLs lead to better prevention and care