E D I T O R I A L Drug Formularies in Correctional Settings Nathaniel P. Morris, MD, Matthew E. Hirschtritt, MD, MPH, and Anthony C. Tamburello, MD J Am Acad Psychiatry Law 48:2– 6, 2020. DOI:10.29158/JAAPL.003907-20 Drug formularies are a key determinant of access by incarcerated patients to psychotropic medications. The National Commission on Correctional Health Care (NCCHC) defines a formulary as “a written list of prescription and nonprescription medications that are ordinarily available to authorized prescribers, in- cluding consultants, working for the facility” (Ref. 1, p 71). Medications that are not listed on a formulary, often referred to as nonformulary medications, may have different degrees of availability. Some nonfor- mulary medications may be approved for use if pa- tients meet specific clinical criteria, whereas other medications may be entirely unavailable or prohib- ited from use. For example, the U.S. Federal Bureau of Prisons (BOP) Health Services National Formulary lists more than 20 medications commonly used in psy- chiatric treatment that are either nonformulary or require approval prior to use. 2 In these facilities, mental health professionals must navigate restric- tions when attempting to prescribe numerous classes of medications, including specific antidepressants, antipsychotics, anxiolytics, gabapentinoids, stimu- lants, and medications for addiction treatment. 2 While this formulary does not specify why medica- tions in many of these classes are restricted, these restrictions limit which patients can receive specific medications, the types of medication formulations that can be offered by prescribers, and the maximum allowable dose and duration of pharmacotherapy. Additional restrictions beyond the BOP formulary may apply when prescribing to incarcerated patients in U.S. federal prisons. 3 As a case in point, the BOP formulary lists methadone as a formulary medica- tion, but it also refers clinicians to a BOP Pharmacy Services policy that inmates with opioid use disorders “will not be maintained on methadone with the ex- ception of pregnant inmates” (Ref. 4, p 37). Although most health care settings have some lim- itations regarding patients’ access to medications, drug formularies in correctional settings play a sig- nificant and underrecognized role in the practice of psychiatry within the United States. These formular- ies deserve further attention from both mental health professionals and policymakers because they can re- strict incarcerated patients’ abilities to access psycho- tropic medications. Concerns About Correctional Formularies Formularies can limit inmates’ access to medica- tions commonly used in psychiatric care. In 2017, jails and prisons in the United States handled more than 11 million admissions and held approximately 2 million incarcerated individuals at any one time. 5,6 Incarcerated individuals tend to experience higher rates of mental disorders, substance use disorders, and co-occurring medical conditions compared with the general population. 7-10 Studies of incarcerated Dr. Morris is a Chief Resident in Psychiatry at the Stanford University School of Medicine. Dr. Hirschtritt is a Volunteer Clinical Professor in the Department of Psychiatry at the University of California, San Francisco and Associate Physician in The Permanente Medical Group. Dr. Tamburello is the University Correctional Health Care Statewide Associate Director of Psychiatry and a Clinical Associate Professor at the Robert Wood Johnson Medical School at Rutgers University. Ad- dress correspondence to: Nathaniel P. Morris, MD, 401 Quarry Rd, Stanford, CA 94304. E-mail: npm@stanford.edu. Disclosures of financial or other potential conflicts of interest: None. 2 The Journal of the American Academy of Psychiatry and the Law