Hospital Formulary Management and Drug Budget Control at Federal Medical Centres in South South Nigeria: Challenges and Solutions

Hospital formulary management is a strategic tool for rationalizing drug expenditure, improving therapeutic consistency, and reducing medication errors. In federal medical centres across South South Nigeria, formulary governance structures are often weak or informally implemented, leading to budget overruns and suboptimal prescribing outcomes. This study investigated the current state of formulary management and drug budget control at federal medical centres in South South Nigeria, focusing on facilities in Rivers, Delta, and Bayelsa States. A cross-sectional design was employed, with structured interviews conducted among 30 pharmacists, pharmacy directors, and medical directors, supplemented by document review of formulary lists, procurement records, and drug budget utilization reports for a two-year period. Findings indicated that only two of six facilities had formally adopted and actively enforced a drug formulary. Therapeutic committee meetings were irregular in four sites, and pharmacist representation was absent in drug procurement decision-making in three facilities. Average drug expenditure exceeded budgeted allocations by 38 percent over the review period. Key factors driving overspending included emergency procurement at premium prices, non-formulary physician preferences, and supply chain inefficiencies. The study proposes a formulary governance model integrating pharmacist leadership, mandatory therapeutic committee oversight, and electronic formulary enforcement tools. Adoption of this model is recommended as an urgent institutional priority for federal medical centres across South South Nigeria. Keywords: hospital formulary, drug budget, federal medical centres, South South Nigeria, pharmaceutical management