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Collaboration Across the Spectrum of Formulary Decision-Making: From Hospitals to Health Authorities to Public Drug Plans

CADTH 2015 Symposium PanelSaskatoon, SKApril 13, 2015

Eric Lun, PharmD, ACPR, BSc PharmExecutive Director, Drug Intelligence & Optimization Branch

Medical Beneficiary and Pharmaceutical Services Division, Ministry of Health

Disclosure

No conflict of interests to disclose

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Outline

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 II. CDR (CADTH) III. BC IV. Pan-CanadianCanada Pharmaceutical

Alliance(pCPA)

NOC or NOC/c

§Efficacy vs. placebo§Safety§Quality of manufacture

Health Canada

Common Drug

Review

Manufacturer

· Clinical-effectiveness · Cost-effectiveness

Listing Recommendation

New Drugs, New Combinations and New Indications

for Old Drugs

• Evidence-informed process• Aim to select best drugs for best value

Drug BenefitCouncil (DBC)

Generic drugsPatented drugs

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Various Drug Review Processes in BC Ministry of Health BC PharmaCare Formulary Regional Health Authorities (5)

VIHA, VCHA, FHA, IHA, NHA Provincial HA P&T Committee single HA formulary

BC Centre for Excellence HIV/AIDS Provincial Health Services Authority

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

Collaboration Experience in BC Provincial HA P&T Process

Ministry participation – member on P&T, participate on working committees; share information

“Transition care” drugs have greater relevance E.g., LMWH or NOAC post hip/knee surgery, anti-platelet post PCI

Ministry’s drug review process 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 & DifferencesPUBLIC 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 Improve medication continuity at care transitions

Transitions in/out of acute care institutions Medication reconciliation

Improve patient care quality and continuity between community care and acute care 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 Managing or reconciling governance, mandate, and fiscal

accountability differences Drug review process

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 Formulary collaboration between hospital and public

drug plans are at various levels of collaboration

Need to recognize similarities and differences

Identify common ground with opportunities

Address differences and challenges where possible

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