title: Formulary compliance and pharmacy labor costs associated with systematic formulary management strategy.
abstract: OBJECTIVE
  The impact of a comprehensive hospital formulary management system on formulary compliance and pharmacy labor costs was evaluated.
  
  
  METHODS
  The formulary management system consisted of monitoring nonformulary medication use, reviewing formulary medication use annually, and providing periodic feedback. Workflow scenarios for nonformulary medication requests were identified. Pharmacy personnel were interviewed to obtain the probability of occurrence of each scenario and the time involved. Labor costs were determined by multiplying the average total minutes spent on each activity by the corresponding average salaries per minute. Formulary compliance was compared before the implementation of the formulary management system (January to June 2008) with six consecutive six-month periods after implementation.
  
  
  RESULTS
  Nonformulary medication use decreased from 17.8 to 5.9 nonformulary medication initiations per 100 admissions over a three-year period (p < 0.001). Time and labor costs associated with managing nonformulary medication requests varied from 4 to 69 minutes and from $3.68 to $27.28, respectively, depending on the scenario used. Automatically converting to a formulary alternative was the least labor-intensive option ($4.40 per request), followed by changing to a formulary alternative after consulting the prescriber ($9.92).
  
  
  CONCLUSIONS
  A comprehensive formulary management system resulted in increased compliance to a formulary that matched the needs of the institution and minimized the number of nonformulary medication requests. Expanding pharmacists' therapeutic interchange authorities was the least labor-intensive way of managing nonformulary medication requests, and adding the most frequently used nonformulary medications to the formulary was the second least costly option.
authors.affiliation: Pieter J. Helmons, Pharm.D., M.A.S., is Hospital Pharmacist, St. Jansdal Hospital, Harderwijk, Netherlands; at the time of this study he was Pharmacist Specialist-Pharmacoeconomics, University of California San Diego (UCSD), San Diego. Jos G. W. Kosterink, Ph.D., Pharm.D., is Hospital Pharmacist and Head of Department of Hospital and Clinical Pharmacy, University Medical Center Groningen, Groningen, Netherlands, and Clinical Pharmacologist, Pharmacotherapy and Pharmaceutical Care Unit, Department of Pharmacy, University of Groningen. Charles E. Daniels, Ph.D., B.S.Pharm., is Professor of Clinical Pharmacy and Associate Dean for Clinical Affairs, Skaggs School of Pharmacy and Pharmaceutical Sciences, UCSD, and Pharmacist-In-Chief, Department of Pharmacy, UCSD Health System, San Diego.
authors.forename: Pieter J
authors.initials: PJ
authors.lastname: Helmons
authors.forename: Jos G W
authors.initials: JG
authors.lastname: Kosterink
authors.forename: Charles E
authors.initials: CE
authors.lastname: Daniels
mesh_terms: D003365:Costs and Cost Analysis; D016527:Drug Costs; D004363:Drug Utilization / Q000706:statistics & numerical data; D005572:Formularies, Hospital as Topic / Q000592:standards*; D019983:Guideline Adherence; D008331:Management Information Systems; D010605:Pharmacy Administration; D010607:Pharmacy Service, Hospital / Q000191:economics* / Q000592:standards*; D010596:Pharmacy Technicians; D012456:Salaries and Fringe Benefits; D057188:Workflow; D000078329:Workforce