Background <p>Despite the increasing emphasis on safe prescribing, the impact of local formularies on physician behavior remains underexplored in community healthcare settings. To promote safer pharmacological practices, our institution implemented a hospital-originated sleep-medication formulary in January 2022, which was subsequently disseminated to other local medical institutions in early 2023. This study assessed physicians’ awareness of this sleep-medication formulary, and its influence on prescribing behavior in local community healthcare settings.</p> Methods <p>A questionnaire survey was distributed via a regional medical-cooperation newsletter and responses were received from 84 physicians.</p> Results <p>Of the 84 physicians, 18% were aware of the formulary. Physicians in the awareness group were more likely to prescribe the recommended medications, particularly orexin receptor antagonists, and reported significantly less difficulty in initiating hypnotic therapy. Logistic regression analysis revealed a significant association between formulary awareness and reduced difficulty in prescribing a suitable hypnotic (odds ratio: 0.24; 95% CI: 0.073–0.78).</p> Conclusions <p>Local formularies may serve as valuable tools in clinical decision-making and promote safer and more consistent prescribing practices. Strategies such as physician education, concise formulary reference sheets or physician-oriented pocket references, and the development of patient-friendly information materials are warranted to support broader implementation.</p> Trial registration <p>Not applicable.</p>