Revision and maintenance of a hospital formulary are core responsibilities in pharmacy practice that ensure safe, effective, and cost‑efficient drug therapy. This introduction explains key concepts like formulary management, drug selection criteria, therapeutic interchange, pharmacoeconomics, drug utilization review (DUR), P&T committee roles, drug monographs, inventory control, and guideline implementation. B.Pharm students will learn practical steps for periodic review, handling drug shortages, evaluating new drugs, and applying evidence‑based medicine to formulary decisions. Understanding documentation, audit metrics, and regulatory compliance helps pharmacists sustain a rational and updated formulary aligned with patient safety and institutional goals. Now let’s test your knowledge with 30 MCQs on this topic.
Q1. What is the primary purpose of a hospital formulary?
- To list only expensive brand-name drugs
- To provide an evidence-based list of approved medications for safe and cost-effective use
- To replace national essential medicines lists
- To serve solely as a purchasing catalogue for vendors
Correct Answer: To provide an evidence-based list of approved medications for safe and cost-effective use
Q2. Which committee is usually responsible for formulary revision and maintenance?
- Infection control committee
- Pharmacy and Therapeutics (P&T) committee
- Finance committee only
- Nursing council
Correct Answer: Pharmacy and Therapeutics (P&T) committee
Q3. Which document provides a summary of clinical, pharmacological, and economic information for a drug during formulary review?
- Drug monograph
- Patient consent form
- Purchase order
- Manufacturer promotional brochure
Correct Answer: Drug monograph
Q4. What is therapeutic interchange?
- Switching a drug for a chemically unrelated therapeutic class
- Substituting a therapeutically equivalent drug, typically within the same class, under protocol
- Changing route of administration without changing the molecule
- Replacing a drug with a placebo for research
Correct Answer: Substituting a therapeutically equivalent drug, typically within the same class, under protocol
Q5. Which factor is NOT usually considered in formulary drug selection?
- Clinical efficacy and safety
- Cost-effectiveness and pharmacoeconomics
- Manufacturer marketing budget
- Availability and supply stability
Correct Answer: Manufacturer marketing budget
Q6. How often should a hospital formulary typically undergo formal review?
- Every 10 years
- Only when there is a new drug on the market
- Periodically (commonly annually or biennially) and as-needed for safety or supply issues
- Never after initial implementation
Correct Answer: Periodically (commonly annually or biennially) and as-needed for safety or supply issues
Q7. What is a drug utilization review (DUR) primarily used for in formulary maintenance?
- To audit prescribing patterns and ensure rational use of formulary drugs
- To increase drug prices
- To promote brand-name prescribing only
- To decide staffing levels in the pharmacy
Correct Answer: To audit prescribing patterns and ensure rational use of formulary drugs
Q8. Which metric is commonly used to evaluate formulary performance?
- Number of generic substitutions per year
- Medication error rate, drug utilization trends, cost per defined daily dose
- Number of advertisements in clinical journals
- Length of the formulary document in pages
Correct Answer: Medication error rate, drug utilization trends, cost per defined daily dose
Q9. When a new high-cost drug is considered for formulary addition, which assessment is most critical?
- Color of the drug packaging
- Pharmacoeconomic analysis including cost-effectiveness and budget impact
- Number of celebrities endorsing it
- Office location of the manufacturer
Correct Answer: Pharmacoeconomic analysis including cost-effectiveness and budget impact
Q10. Which of the following best describes a restricted formulary?
- All drugs are freely available without any controls
- Selections are limited and some drugs require approval or criteria before use
- Only herbal medicines are allowed
- Formulary decisions are made randomly
Correct Answer: Selections are limited and some drugs require approval or criteria before use
Q11. What role does an antibiogram play in formulary decisions?
- Determines prices for antibiotics
- Guides empirical antibiotic selection based on local susceptibility patterns
- Lists only antiviral agents
- Is unrelated to formulary management
Correct Answer: Guides empirical antibiotic selection based on local susceptibility patterns
Q12. Which action should be taken during a drug shortage as part of formulary maintenance?
- Immediately remove all alternatives from the formulary
- Implement therapeutic alternatives, conservation strategies, and communicate with clinicians
- Ignore the shortage and continue standard orders
- Increase automatic dispensing quantities
Correct Answer: Implement therapeutic alternatives, conservation strategies, and communicate with clinicians
Q13. What is the importance of documenting formulary decisions?
- To provide transparency, rationale, and regulatory compliance for drug selection and restrictions
- To increase the length of administrative files only
- To avoid clinical input completely
- To hide conflicts of interest
Correct Answer: To provide transparency, rationale, and regulatory compliance for drug selection and restrictions
Q14. How does therapeutic duplication affect formulary maintenance?
- It has no clinical consequences
- It increases risk of adverse effects, waste, and requires formulary checks to prevent duplication
- It is encouraged to enhance treatment
- It reduces medication reconciliation needs
Correct Answer: It increases risk of adverse effects, waste, and requires formulary checks to prevent duplication
Q15. For biosimilars, which consideration is especially relevant in formulary decisions?
- Exact molecular identity with reference biologic
- Evidence on interchangeability, clinical efficacy, safety, and immunogenicity
- Whether the biosimilar uses the same color labeling
- Manufacturer’s country alone
Correct Answer: Evidence on interchangeability, clinical efficacy, safety, and immunogenicity
Q16. What is a formulary exclusion list?
- A list of drugs that are actively promoted
- A list of medications intentionally not approved for use due to safety, cost, or lack of efficacy
- A shopping list for patients
- A list of expired drugs in stock
Correct Answer: A list of medications intentionally not approved for use due to safety, cost, or lack of efficacy
Q17. Which is a critical element of inventory control in formulary maintenance?
- Random disposal of excess stock
- Regular stock review, minimum/maximum levels, and rotation of expiry dates
- Never performing stock reconciliation
- Ordering only once a year
Correct Answer: Regular stock review, minimum/maximum levels, and rotation of expiry dates
Q18. What is the role of clinical guidelines in formulary revision?
- They are irrelevant to formulary choices
- They provide evidence-based recommendations that support inclusion or restriction of therapies
- They replace P&T committee deliberations entirely
- They only apply to surgical instruments
Correct Answer: They provide evidence-based recommendations that support inclusion or restriction of therapies
Q19. Which documentation supports a decision to add a new drug to the formulary?
- Clinical trial data, comparative efficacy, safety profile, cost-effectiveness, and local need assessment
- Only the drug’s marketing slide deck
- Employee testimonials
- A single anecdotal case report without context
Correct Answer: Clinical trial data, comparative efficacy, safety profile, cost-effectiveness, and local need assessment
Q20. What is a formulary therapeutic alternative policy?
- A policy that forces prescribers to use brand names
- A policy allowing substitution of clinically equivalent agents to optimize therapy and cost
- A policy to restrict all injections
- A policy that disallows any substitution
Correct Answer: A policy allowing substitution of clinically equivalent agents to optimize therapy and cost
Q21. What is the significance of adverse drug reaction (ADR) reporting in formulary maintenance?
- ADR data help identify safety signals and prompt review or removal of formulary drugs
- ADRs are irrelevant once a drug is on the formulary
- ADR reporting is only for research not practice
- ADRs always lead to immediate formulary bans without review
Correct Answer: ADR data help identify safety signals and prompt review or removal of formulary drugs
Q22. Which approach improves prescriber adherence to formulary recommendations?
- Education, easy access to formularies, computerized decision support, and feedback on prescribing
- Refusing to answer prescriber questions
- Removing all therapeutic alternatives
- Delivering policies only in long printed binders
Correct Answer: Education, easy access to formularies, computerized decision support, and feedback on prescribing
Q23. What is the Defined Daily Dose (DDD) used for in formulary evaluation?
- Calculating average maintenance dose per day for drug utilization studies and comparisons
- Determining the maximum tolerated dose in trials
- Setting patient-specific dosing instructions
- Measuring pill size
Correct Answer: Calculating average maintenance dose per day for drug utilization studies and comparisons
Q24. Which of the following is a challenge in maintaining a formulary in tertiary hospitals?
- Low complexity of cases
- High volume of specialized drugs, frequent new approvals, and diverse clinical needs
- Unlimited budget
- Uniform patient population
Correct Answer: High volume of specialized drugs, frequent new approvals, and diverse clinical needs
Q25. What is the best practice for handling off-formulary requests?
- Ignore requests until they stop
- Have a formal, documented process for rapid review, clinical rationale, and temporary approvals when justified
- Automatically approve all off-formulary requests
- Delegate decisions solely to sales representatives
Correct Answer: Have a formal, documented process for rapid review, clinical rationale, and temporary approvals when justified
Q26. Which statement about generic substitution in a formulary is correct?
- Generic substitution is never allowed
- Generic substitution can improve affordability and is supported when bioequivalence is established
- Generics always have different therapeutic effects
- Substitution should occur without any policy or oversight
Correct Answer: Generic substitution can improve affordability and is supported when bioequivalence is established
Q27. How should conflicts of interest be managed during formulary decisions?
- They should be ignored
- Disclosed and managed by recusal or transparency to maintain integrity
- Committee members should be prohibited from attending any meetings
- Only marketing personnel should decide
Correct Answer: Disclosed and managed by recusal or transparency to maintain integrity
Q28. What role does electronic formulary (e-formulary) integration play in hospitals?
- Complicates prescribing processes only
- Enhances access, supports clinical decision support, and reduces prescribing errors
- Eliminates the need for P&T committees
- Is only useful for billing
Correct Answer: Enhances access, supports clinical decision support, and reduces prescribing errors
Q29. Which is an appropriate response when a formulary drug shows increased adverse events in post-marketing surveillance?
- Immediate permanent removal without review
- Initiate safety review, assess causality, consider restriction, monitoring, or removal based on evidence
- Ignore reports as anecdotal
- Increase stock levels to ensure availability
Correct Answer: Initiate safety review, assess causality, consider restriction, monitoring, or removal based on evidence
Q30. What is a key outcome measure to demonstrate the value of formulary management?
- Number of pages in the formulary document
- Improved clinical outcomes, reduced adverse events, and cost savings or cost-effectiveness
- Total number of drugs listed regardless of use
- Frequency of committee meetings only
Correct Answer: Improved clinical outcomes, reduced adverse events, and cost savings or cost-effectiveness
I am a Registered Pharmacist under the Pharmacy Act, 1948, and the founder of PharmacyFreak.com. I hold a Bachelor of Pharmacy degree from Rungta College of Pharmaceutical Science and Research. With a strong academic foundation and practical knowledge, I am committed to providing accurate, easy-to-understand content to support pharmacy students and professionals. My aim is to make complex pharmaceutical concepts accessible and useful for real-world application.
Mail- Sachin@pharmacyfreak.com