Ethics of nonformulary review in psychiatry.

Quality assurance programs have infiltrated all aspects of patient care. No longer is the clinician immune from outside forces influencing the conduct of treatment. External utilization review may independently determine the length of inpatient stay that will be reimbursed. This month's column discusses how internal review may direct which medications are available for use by the prescribing physician in the hospital. To what extent such review is intended primarily to benefit patients or to control costs is subject to debate. Regardless of motive, the result is considerable ethical controversy.