Developing a national formulary based on a unified payment system in Iran

Abstract

Introduction: The national formulary plays an important role in increasing access to medicine and correct drug information based on national considerations. However, this study aimed to provide a model for development of national formulary based on a unified payment system in Iran.

Methods: This study used a combination of descriptive, comparative, and qualitative methods. It was an applied developmental study in 2016. The data were collected using a form based on the World Health Organization’s (WHO) standard model for national formulary. Using census method, all national formulary of countries available on the WHO website (n=14) were selected for study. The similarities and differences of national formulary of these countries and Iran were compared with the WHO’s standard model. Then, Iran’s national formulary content was determined using comparative study results and opinions of an expert panel consisting of 12 faculty members and assistants of the medicine economy.

Results: Results showed that the content of national formulary in studied countries is consistent with the WHO model. They consisted of four parts: introductory information, medicine information and monograph, appendices, and alphabetical index. In the introductory, which was out of elements of the WHO, the drug selection and advice to patients’ criteria in the preliminary information part of used dose and its side effects in drug monograph and information had the highest frequency. The lowest frequency was for medicine pharmacology and pharmacokinetics in the medicine monograph section. The most common data element in the appendix was related to drug interactions, and the lowest frequency was related to hepatic impairment and renal impairment. All data elements were confirmed by an expert panel. They stated that, after the component of common brand name, the drug cost effectiveness and drug code are necessary for each drug in the drug monograph section.

Conclusion: This study provided an updated model and structure for developing national formulary of Iran based on a unified reimbursement system, WHO model, comparative study of national formulary of selected countries, and the opinion of an expert panel in the field of medicine economy. This model may provide reliable information for health employees and managers and improve the effective and safe use of medicines. Also, the creation of drug formulary based on this model and using it may facilitate the selection of standard and high-quality medicines from among different companies and brands, comparing them with each other, prescribing high-quality medicine with lower price, and avoiding the impact from advertisements.