Module 32: Formulary, Non-Formulary & Therapeutic Interchange—Without Friction

In your retail practice, you are a master of managing a vast and unpredictable inventory. You are the short-order cook in a bustling diner. A customer can walk in with a prescription for almost anything, and your job is to procure and dispense it, navigating the complex supply chain of wholesalers and manufacturers. Your focus is on the individual “order” and your primary skill is acquisition.

This module prepares you for your new role as the Executive Chef of a Michelin-starred restaurant. You are no longer just filling orders; you are meticulously curating the entire pantry. The hospital formulary is your menu—a carefully selected list of ingredients (medications) chosen for their proven quality (efficacy), safety, and value (cost). You cannot simply have every ingredient in the world; that would be inefficient, wasteful, and dangerous. Instead, you work with a team of culinary experts (the P&T Committee) to select the best possible ingredients to create the best possible dishes (patient outcomes).

Your new challenge is to manage this curated menu with skill and diplomacy. When a visiting “guest chef” (a new attending physician) wants to use an exotic, off-menu ingredient (a non-formulary drug), you must have the expertise to suggest an approved, on-menu alternative that achieves the same culinary effect (a therapeutic interchange). This module is your culinary school for formulary management. It will teach you how to defend the menu, how to make brilliant substitutions, how to tactfully handle special requests, and how to do it all while earning the respect and trust of the entire kitchen staff.