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

Disclosure No conflict of interests to disclose 2

Outline BC Ministry of Health - Drug Review Process BC Collaboration Context Recognize Similarities & Differences Collaboration Challenges Collaboration Opportunities Summary 3

4 BC Ministry of Health Drug Review Process I. Health II. CDR (CADTH)III. BCIV. Pan-Canadian CanadaPharmaceutical Alliance(pCPA) Evidence-informed process Aim to select best drugs for best value Drug Benefit Council (DBC) Generic drugs Patented drugs

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

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 6

Recognize Similarities & Differences PUBLIC DRUG PLANSHOSPITAL / HEALTH AUTHORITY or REGION Program Funding: PublicPublic Patient care: Indirect (policy)Direct Drug Costs: Reimburse cost of drugsBuy drugs Drug funding duration: Maybe indefiniteAvg. Inpatient LOS 7.7 days ( CIHI) Drug Supply: fund pharmacies to dispensePharmacy - inventory, repackage, dispense Pharmacy professional services: feesPharmacy service operations Drug Review Process (DRP): DRP submissions – mostly manufacturersUsually clinician submission DRP resources – CADTH, other contractsVariable staff capacity and capabilities Pricing - PCPAGroup Purchasing Organizations (GPO) Implementation – generally less complicated Implementation - may include changes to hospital protocols, inventory, repackaging 7

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 8

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 9

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 10