EHR preference lists were not designed to manage a formulary, and the gap between what they can do and what formulary management actually requires is wider than most pharmacy leaders realize until something goes wrong.
Most health systems maintain their formulary through Epic, Cerner or another EHR, and it makes sense on the surface. The EHR is where everyone already is. Building something within it feels effective (and cost-efficient too). But a preference list and a formulary are not the same thing and treating them as interchangeable creates a compliance problem that is hard to see coming (and can cost more than you expect).
Why can’t an EHR preference list do this job?
An average health system formulary has over 2,000 drugs. Every one of them needs to be manually maintained and updated every time something changes:
We had a client on the West Coast who cleaned out their Epic preference list when they transitioned to Formweb. What they found was sobering: outdated restrictions throughout, missing information, broken links. They’d had no idea. How would they? Nobody set out to let it get that way. It just accumulated, quietly, until someone went looking. That story is not unusual.
What are clinicians actually looking for when they access formulary information?
When we look at the analytics from health systems using a dedicated formulary system, 46% of sessions start with a policy or guideline review, not a drug lookup. One client had a single glucose management policy accessed 47,000 times in one year.
Clinicians aren’t only checking what’s on formulary. They’re looking for the guidance their organization has agreed on: the restrictions, the criteria, the context that helps them act confidently at the bedside. An EHR preference list tells them what’s stocked, but surfacing the full picture of supporting information clinicians need at the point of care is a different problem entirely.
When they have to leave the EHR to find it, through Sharepoint, a binder, or another system, a significant portion of them just won’t. We found clinicians were 85-90% more likely to use safety information when it was accessible within their existing workflow. That one step outside the EHR changes the behavior entirely.
What does this mean for compliance?
A formulary that lives primarily in an EHR preference list tends to drift. Here is what that looks like in practice:
One 10-hospital system recently attributed $35 million in savings to getting its formulary right: accurate, accessible, and consistently communicated across every site. The savings came from therapeutic interchanges being followed, non-formulary purchasing getting flagged, and clinicians staying within what the health system actually stocked. The formulary was doing its job because people could find it and use it.
EHRs serve an important purpose, but managing a formulary is not among them. The function requires its own infrastructure, one that can be audited, updated enterprise-wide, and accessed by everyone who needs it in the format they need it.
BOTTOM LINE: The formulary you think you have and the formulary that’s actually being used by your clinical team may not be the same thing. Finding that out proactively is always better than the alternative.
If you’d like to see what a dedicated formulary system looks like in practice, you can explore it at formweb.com/demo, no signup required.