OBJECTIVES: Hospital formularies are usually the gatekeepers for pharmaceutical drugs. Typical majority members of hospital formularies are physicians, although most of the time the formulary is chaired by a pharmacist. As German hospitals are struggling with a difficult economic environment the question arises: what kind of decision-making criteria are applied when pharmaceutical drugs should be added to the formulary list? Information regarding this topic is scarce due to the sensitive topic of decision-making. Only one study (Thürmann et al., 1997) is looking into this for Germany. METHODS: 588 public, private and ecclesiastic hospitals in Germany have been contacted to participate in an online-survey regarding the structure of their hospital formulary, roles of members and applied decision-making criteria. RESULTS: 35 of 588 hospitals (6%) have finally participated and filled out the complete questionnaire. Out of the 35 participants, 29 were pharmacists (82.9%) and 6 were physicians (17.1%). 34.3% of the hospitals have no guidelines for their decision-making and 65.7% of the hospitals with guidelines have written (48.6%) or verbal (17.1%) guidelines. Out of these, 78.3% discuss decision-making criteria, but only 47.8% talk about the relative importance of the discussed decision-making criteria. Budget impact (82.6%), clinical studies (69.6%) and price (65.2%) are the most often mentioned decision-making criteria in the guidelines. CONCLUSIONS: A third of the participating hospitals do not have guidelines for their decision-making process and only half of the guidelines discussing decision-making criteria also talk about the relative importance. Hospital formularies in Germany do not seem to be transparent in their decision-making process. In addition the top 3 decision criteria in the existing guidelines include 2 economical criteria which lead to the question of dominance of economical versus medical or other criteria. Further research needs to look at the real applied decision-making criteria and how much impact economical criteria have on decision-making in German hospital formularies.