Dear Members,

On 31st January, 2005, the Panel on Health Services of the Legislative Council will hold a special meeting to discuss the Hospital Authority's proposal on the introduction of a standard drug formulary.

The agenda of the said meeting is here:

http://www.legco.gov.hk/yr04-05/english/panels/hs/agenda/hsag0131.htm

The paper jointly tabled by the HA and the Health, Welfare and Food Bureau is here:

http://www.legco.gov.hk/yr04-05/english/panels/hs/papers/hs0131cb2-746-1e.pdf

Here is a summary of the classification of drugs proposed:

HA Standard Drug Formulary (醫管局標準藥物名冊)

Objective

The main objective of developing an HA-wide Standard Drug Formulary is to ensure equitable access to cost effective drugs of proven efficacy and safety, through standardisation of drug policy and utilisation in all HA hospitals and clinics

Content of the Standard Drug Formulary

The Standard Drug Formulary will contain two categories of drugs, namely General Drugs (通用藥物) and Special Drugs (專用藥物).

General Drugs refer to drugs with well-established indications and effectiveness which are available for general use as indicated by the patients' clinical conditions. This group comprises around 85% of the drugs within the Formulary. This category of drugs is provided within the standard fees and charges at public hospitals and clinics.

Special Drugs refer to drugs which are to be used under specified clinical conditions with specific specialist authorisation. This group comprises less than 15% of the drugs within the Formulary. Generally speaking, drugs within this group are newer, more expensive, and with variable existing practices at the HA. Provided that the drug usage is within the specific indications, these second-line drugs are provided within the standard fees and charges.

Drugs outside the Standard Drug Formulary (Non standard drugs)

Generally speaking, four main types of drugs have not been included in the draft Standard Drug Formulary, guided by the principles of evidence-based medical practice, targeted subsidy and opportunity costs considerations. Most of these drugs are already self-financed by patients at present. These include:

1. Drugs proven to be of significant benefits but extremely expensive for the HA to provide as part of its subsidised service: Drugs within this group are new and usually only indicated in advanced stages of diseases and beyond currently available standard modalities of treatment. An example of this type of drug is Imatinib (Glivec). These drugs are not covered under the standard fees and charges of public hospitals and clinics. However, it is recognised that for patients, such drugs are proven to be of significant benefits, and patients who have difficulties in meeting the drug expenses will be covered by a financial safety net.
2. Drugs which have preliminary medical evidence only: One of the examples of drugs with limited therapeutic evidence is Gefitinib (Iressa) in the treatment of lung cancer where efficacy is only supported by a small number of clinical trials and considered questionable by the Food and Drug Administration of the United States.
3. Drugs with marginal benefits over available alternatives but at significantly higher costs: Examples of drugs with high cost but only marginal benefits are the COX II inhibitors. The daily cost of these drugs is ten times higher than the usual daily cost for the class of conventional non-steroidal anti-inflammatory drugs, and the claimed benefits of COX II inhibitors are only marginal.
4. Life style drugs: Examples of life style drugs include erectile dysfunction drugs, e.g. Sidenafil (Viagra); hair growth drugs, e.g. Finasteride (Propecia); and anti-obesity drugs, e.g. Orlistat (Xenical).

The above drugs will be non-standard provisions in the HA and patients will have to purchase these drugs at their own expenses.

The introduction of the HA standard drug formulary is bound to have profound impact on hospital pharmacy practice. After the Health Panel meeting on 31st January, a 3-month consultation period is expected to commence, and the SHPHK's position will be sought. You are strongly urged to download and read the LegCo paper, and to send your comments to the General Committee (e-mail: gc(at)shphk(dot)org(dot)hk), so that our response will be truly representative of your views.

Please act now. It is important.

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