OBJECTIVES:  To determine whether the decisions made by the formularies of the 14 NHS Health Boards in Scotland match recommendations made by the SMC. METHODS:  SMC recommendations for technologies appraised between January and March 2016 were collected from the SMC website. Inclusion/exclusion decisions made by each of the 14 formularies for each technology were collected from Health Board websites and compared to the recommendations made by the SMC. Medicines where a formulary decision had not yet been made were recorded as ‘not included’. Formulary decisions for the NHS Orkney and NHS Shetland Health Boards use those made by NHS Grampian, and decisions for NHS Western Isles use those made by NHS Highland. RESULTS: A total of 23 technologies were appraised by the SMC between January and March 2016, of which 16 were recommended (with or without a restriction) and 7 not recommended. Technologies not recommended by the SMC were not included on any of the 14 formularies. Of the technologies recommended by the SMC, the formulary inclusion rate was relatively low, at 45.1%, with the highest inclusion rate observed in Greater Glasgow and Clyde (93.8%) and the lowest in Lanarkshire (18.8%). There did not appear to be any regional divide in decision outcomes between Eastern and Western Health Boards, with inclusion rates of 42.9% and 47.3%, respectively. For medicines accepted by the SMC but not included by formularies, the most common reason for exclusion was failure of clinicians to respond to the invitation to apply for formulary inclusion. CONCLUSIONS: Inclusion rates by formularies for SMC-recommended technologies are surprisingly low, suggesting that Health Boards do not always follow the SMC’s decisions, at least in the months immediately after the SMC decision has been made. Medicines may not be available on formularies as soon as they are approved by the SMC.