South Australian Medicines Formulary fact sheet for SA Health staff
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SA Health is committed to promoting quality use of medicines (QUM), improving equity of access to medicines for patients and achieving cost-effective use of medicines. The development and introduction of the South Australian Medicines Formulary will assist in achieving these goals.
A list of medicines available for prescribing and dispensing at a particular hospital or health service is referred to as the medicines formulary.
The majority of South Australian (SA) Public Hospitals have had local medicines formularies in place for many years.
A medicines formulary assists in standardising prescribing and ensuring equity of access.
Currently there is variation in formularies between different SA hospitals. This results in inconsistencies between hospitals which can lead to inequality, as patients may be offered different medicines to treat the same condition at different hospitals.
Differences in formularies may also result in Clinical staff being unfamiliar with the available medicines. This may result in delays to treatment or contribute to medication misadventure.
Multiple formularies also mean duplication of effort with most SA Public Hospitals having individual Drug and Therapeutic Committees (DTC) to evaluate the safety, efficacy and cost-effectiveness of medicines before inclusion on the formulary.
Considerable financial opportunities may be realised by purchasing medicines using a state-wide approach.
All medicines in use and proposed for use in South Australian public hospitals are within the scope of the formulary considerations.
Medicines will be reviewed in groups according to therapeutic usage. Within a group there may be multiple therapeutic classes. Medicines are considered in the same therapeutic class if they are similar and produce a similar response and are used to treat the same condition.
Medicines in each therapeutic class will be compared, and the following criteria considered
Within each therapeutic class there will a preferred medicine that is recommended ahead of other similar medicines. Within some therapeutic classes there may be more than one option or there may be restrictions on use.
A medicine or therapeutic class may be restricted for use in a particular patient group, to certain types of prescribers or by clinical indication.
The South Australian Formulary Committee (SAFC) is responsible for developing, implementing and maintaining the formulary.
Operating as a sub-committee of the South Australian Medicines Advisory Committee (SAMAC), the South Australian Formulary Committee has expert membership across all Local Health Networks (LHN). Expertise includes a broad range of medical specialities, pharmacy, nursing health economics and consumer perspectives.
When expertise is required from specialities not represented, additional members will be invited to participate on an ad hoc basis to ensure consideration of special patient groups.
For a list of current members, see the South Australian Formulary Committee page.
The Formulary process will involve consultation between the South Australian Formulary Committee and other key stakeholders. Stakeholders include the Drug and Therapeutic Committees from each Local Health Network or hospital, Clinical Networks and other Expert or Specialist Groups
All formulary recommendations will be referred to South Australian Medicines Advisory Committee for final approval.
High Cost medicines are those for which the predicted cost to SA Health per year is:
There will be a gradual implementation of the SA Medicines Formulary, with state and local formularies coexisting until SA Medicines Formulary is complete.
As each therapeutic class is reviewed more medicines will be added to the statewide formulary and removed from the local formulary.
Therapeutic classes will be reviewed according to those where the greatest benefit may be achieved.
The time frame for establishment of the formulary is approximately two years with regular review thereafter.
Patients established on a non-formulary medicine will not be changed unless there is a clear clinical reason to do so.
In some cases hospitals may decide to administer a patient’s own medication that has been brought into the hospital from home.
The formulary will list a range of dosage formulations for each medicine, when available and needed to treat SA Health patients. Sometimes not all formulations will be listed on the formulary; however the requirements for paediatrics or patients with swallowing difficulties will be considered.
Where available on the formulary orally disintegrating tablets will be supplied in place of tablets and wafers on prescription orders. See the Orally Disintegrating Tablets (ODTs) (PDF 367KB) for more information.
The state-wide formulary establishment and on-going review may result in medicines previously listed on the formulary being removed.
In some situations the treating clinician may elect to switch patients to the formulary listed medicine.
For those patients where continuation of a non-formulary medicine is appropriate there will be provision for on-going therapy.
For initiation of a non-formulary medicine an Individual Patient Use (IPU) application will need to be submitted and approved by the Drug and Therapeutic Committee at the treating hospital.
If the request is for the use of a medicine which has been considered and not recommended for formulary listing, then the prescriber must demonstrate why there is specific need for this medicine.
The decision may need further approval at state level; particularly for high cost medicines.
A prescriber wanting to add a new medicine or requesting a change to an existing listing would need to complete the standard submission form, and together with appropriate supporting information direct to their hospital Drug and Therapeutic Committee or equivalent committee for endorsement.
The endorsed application will then be submitted to South Australian Formulary Committee for consideration.
South Australian Formulary Committee will follow a similar process to initial therapeutic class review. There may be removal of an existing medicine to allow addition of a new agent.