Download Dr. Eric Lun

Collaboration Across the Spectrum of
Formulary Decision-Making: From Hospitals
to Health Authorities to Public Drug Plans
CADTH 2015 Symposium Panel
Saskatoon, SK
April 13, 2015
Eric Lun, PharmD, ACPR, BSc Pharm
Executive Director, Drug Intelligence & Optimization Branch
Medical Beneficiary and Pharmaceutical Services Division,
Ministry of Health
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Disclosure
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No conflict of interests to disclose
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Outline
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BC Ministry of Health - Drug Review Process
BC Collaboration Context
Recognize Similarities & Differences
Collaboration Challenges
Collaboration Opportunities
Summary
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BC Ministry of Health Drug Review Process
I. Health
Canada
II. CDR (CADTH)
Health
Canada
III. BC
IV. Pan-Canadian
Pharmaceutical
Alliance(pCPA)
Manufacturer
New Drugs, New Combinations
and New Indications
for Old Drugs
§ Efficacy vs. placebo
§ Safety
§ Quality of manufacture
Common
Drug
Review
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Clinical-effectiveness
Cost-effectiveness
NOC or NOC/c
Listing
Recommendation
Drug Benefit
Council (DBC)
Generic drugs
Patented drugs
• Evidence-informed process
• Aim to select best drugs for best value
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Various Drug Review Processes in BC
Ministry of Health  BC PharmaCare Formulary
Regional Health Authorities (5)
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VIHA, VCHA, FHA, IHA, NHA
Provincial HA P&T Committee  single HA formulary
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BC Centre for Excellence HIV/AIDS
Provincial Health Services Authority
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BC Cancer Agency (BCCA) – participates in PCODR
BC Center for Disease Control - vaccines, TB
BC Provincial Renal Agency
BC Transplant Society (BCTS)
BC Children’s Hospital
First Nations Health Authority
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Collaboration Experience in BC
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Provincial HA P&T Process
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Ministry participation – member on P&T, participate on
working committees; share information
“Transition care” drugs have greater relevance
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Ministry’s drug review process
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E.g., LMWH or NOAC post hip/knee surgery, anti-platelet post PCI
HA representatives may attend DBC as observers
HA stakeholders may also submit written input for
consideration
Overall good progress to date with opportunities
for improvement
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Recognize Similarities & Differences
PUBLIC DRUG PLANS
HOSPITAL / HEALTH AUTHORITY or REGION
Program Funding: Public
Public
Patient care: Indirect (policy)
Direct
Drug Costs: Reimburse cost of drugs
Buy drugs
Drug funding duration: Maybe indefinite
Avg. Inpatient LOS 7.7 days (2010-11 CIHI)
Drug Supply: fund pharmacies to dispense Pharmacy - inventory, repackage, dispense
Pharmacy professional services: fees
Pharmacy service operations
Drug Review Process (DRP):
DRP submissions – mostly manufacturers
Usually clinician submission
DRP resources – CADTH, other contracts
Variable staff capacity and capabilities
Pricing - PCPA
Group Purchasing Organizations (GPO)
Implementation – generally less
complicated
Implementation - may include changes to
hospital protocols, inventory, repackaging
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Collaboration Opportunities
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Improve medication continuity at care transitions
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Improve patient care quality and continuity
between community care and acute care
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Transitions in/out of acute care institutions
Medication reconciliation
Strategic provincial disease management or protocols
Continuity of pharmaceutical care (pharmacy services)
Optimize efficiency and timeliness of drug review
processes
Reduce drug costs
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Collaboration Challenges
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Managing or reconciling governance, mandate, and fiscal
accountability differences
Drug review process
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Improve understanding of CADTH process and outputs
Aligning timing & timeliness
Different inputs & decisions considerations
Operational interaction & communication (with drug plans & CADTH)
Collaboration capacity limitations
Formulary alignment with public plans does not address
other privately funded medications (private are ~2/3 drug costs)
Evaluation of collaboration processes and outcomes
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Summary
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Formulary collaboration between hospital and public
drug plans are at various levels of collaboration
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Need to recognize similarities and differences
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Identify common ground with opportunities
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Address differences and challenges where possible
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