Coventry & Warwickshire Prescribing Formulary – Overview
General considerations
A) Preferred, Second-line and Non-Formulary (Qualified) choices
The formulary has been designed to offer the prescriber sufficient evidence based and cost effective first line choices appropriate for the majority of clinical scenarios
Second line choices allow for specifically licensed and/or nationally guided options and together with the first line choices will give the prescriber scope to manage all but a few patients in each therapy area
Non-formulary (Qualified) choices are all other drugs in that BNF section which are considered unnecessary. However in rare circumstances they may be prescribed but the prescriber should justify this and record the selection in the patient record.
B) Specialist Drugs
These are important APC outputs as they guide all prescribers, in secondary and primary care, to those drugs which are considered as “specialist” and into which category they have been placed.
The four categories are:
SI, SA, SC, SO
For explanation of these terms refer to netFormulary end pages when searching for drug/product entry.
C) Liquid preparations
As a general principle licensed medicines should be used whenever possible. Where a patient has, for example, swallowing difficulties and cannot take solid dose medicines then licensed liquid/buccal/patch versions or other alternatives, for example, should be used instead.
This may require a change to another product in the same class of medicine through a review of the patient’s medication.
When there is no alternative please consult the APC guidance on specials for alternative approaches including off label use of licensed products, e.g. dissolving solid dose versions in water, and, as a last resort, ordering unlicensed specials on prescription (See below).
APC Guideline on Specials and alternatives
D) Generic v Branded
Prescribers should always default to the generic version of the drug, and the formulary uses the approved generic names for all preferred and second-line choices, except in the following circumstances;
Bioavailability variation between different manufacturers version sof a drug is clinically important, e.g. theophylline, diltiazem
Local decision makers have approved the use of a particular brand on the grounds of cost-effectiveness, e.g. Venlalic XL®
E) National QIPP indicators
Those drugs, prescribing of which is subject to scrutiny via a national QIPP indicator, are marked with the annotation below.
In these areas prescribers need to give consideration either to the choice of drug, which is reflected in the preferred options e.g. NSAIDs, or the volume of prescribing of a class of drugs, e.g. high dose inhaled corticosteroids.
