CADTH 2015 Symposium

1. 1
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

2. Disclosure
 No conflict of interests to disclose
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3. Outline
 BC Ministry of Health - Drug Review Process
 BC Collaboration Context
 Recognize Similarities & Differences
 Collaboration Challenges
 Collaboration Opportunities
 Summary
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4. 4
BC Ministry of Health Drug Review Process
I. Health II. CDR (CADTH) III. BC IV. Pan-Canadian
Canada 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 Benefit
Council (DBC)
Generic drugs
Patented drugs

5. 5
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

6. 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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7. 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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8. 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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9. 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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10. 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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