what do think about the HA in taking up the sale of all SFI

So far I have not heard a lot about complaints of patients taking an HA SFI prescription to a community pharmacy and got fake drugs. Has DH inspectors made any test purchase and confirmed the problem? What is the scale and severity of the problem? Any figures? Is it big enough to require HA to monopolize the market?

Should there be any problem with quality of the private market, the government should look into it and rectify it in the usual manner. I can't imagine if I bought a bad DVD player or a fan that leaks electricity, the government would ask the EMSD to sell all electrical appliances. What logic is it that HA should sell private drugs?

If the community pharmacies are so untrustworthy, why doesn't the government close down all pharmacies altogether and take over the sales of all drugs? The fact that HA sells private drugs means HA does not trust the government. It would seem an irony to the department of health!

Alas, how would a child mature if we don't even allow it to grow?

The ability of Hong Kong's decision makers to consistently choose the wrong solution is amazing -

Problem: 安老院舍欠缺完善的藥物管理制度。
Answer: 不引進專業人士，反而訓練非專業的人士，進行專業的高風險工作。

Problem: 私營藥物市場的貨源不可靠，市民憂慮買到水貨假貨。
Answer: 不透過立法、執法以提升私營市場的質素，反而直接進駐市場，在非商業的場所從事商業活動。

Problem: 某些新藥物具備充分臨床證據證明有效，惟價格昂貴。
Answer: 不增撥公共資源以達到風險共有化，反而期望患某些病症的人士，補貼患某些其它病症的人士。

It was not a reflex action.
Name: The Hong Kong Medical Association
Date Posted: Jun 12, 06 - 7:14 PM
Email: hkma@hkma.org
Message: Dear Dr. Shea,

The Council of the Hong Kong Medical Association (HKMA) is surprised to find that you have made on 31 May 2006 a casual comment on HKMA openly without any research or contacting HKMA before hand.
The stand of HKMA on the HA’s Drug Formulary was formulated and released in March 2005 after due consultation with both the medical and the pharmaceutical professions. You may visit the HKMA website at www.hkma.org for more detail. For ease of reference the said press release (in both English and Chinese) is reproduced below for your information.

Press Release
18 March 2005

The stance of HKMA on the Draft HA Standard Drug Formulary

In response to the public consultation put forward by the Hospital Authority (HA) on 18 February 2005 for introducing a "Standard Hospital Authority Drug Formulary" in the public hospital system, the Hong Kong Medical Association (HKMA) immediately set up a task force the next day to scrutinize the subject matter with the aim of ensuring the safety and welfare of our community will not be jeopardized under any circumstances. Apart from collecting views within the profession, representatives from pharmacists' associations were also invited to join the discussion and active dialogues were engaged with officials from HA Headquarter Office. After deliberation at the task force meeting and constructive discussion with respective officials, the HKMA hereby spell out its stance as follows:

Title of the drug formulary: It was generally agreed that there should be one drug formulary to unify the existing drug formularies being used in the public hospital system. However, the use of the word "standard" in the name of the proposed drug formulary created misunderstanding of its being the industry and/or professional standard with many associated repercussions. Therefore, we propose that the formulary should be neatly called "Hospital Authority Drug Formulary".

Consultation Period: We regret that the medical and the pharmaceutical profession at large had not been consulted prior to the publication of the draft formulary. Independent views on the clinical efficacy, therapeutic effectiveness and side effects of the drugs in various specialties should be sought from the respective specialty colleges of the Hong Kong Academy of Medicine, which consist of specialists both inside and outside the HA system. It is suggested that the consultation period should be extended to allow time for the colleges to discuss and collect views from their fellows, and for the private medical sector, an important partner in health delivery, to respond to the consultation.

The Review Mechanism: There should be a mechanism for the formulary to be reviewed regularly. We recommend that the formulary should be reviewed annually in consultation with the independent experts from both public and private sectors.

Drug Groups: It was proposed that further investigations should be conducted in exploring the needs to move drugs from one group to another. Because of varying clinical circumstances, drugs either listed as "Non-Standard Drugs" or not even being included anywhere in the HA drug list may be essential to the continuing care of certain patients, especially if they do not tolerate those drugs in the "general use" and "special" categories. It is desirable to make clear this point to avoid any misconception about the drug list, which might have important consequences in relation to clinical practice and insurance coverage.

Safety Net: The provision of a safety net to help patients with difficulties in meeting the drug expenses is welcome. However, its definition and mechanism have not been clearly spelt out. Attention is drawn to situations where a patient may become financially drained after suffering from a disease and buying expensive drugs for a period of time. For example, "GilvecR" is a rather expensive but effective drug in treating chronic myeloid leukemia ("CML") yet it was not put on the proposed formulary. CML is in fact a very rare disease with a limited number of patients suffering from it. If the patient is willing to sacrifice his precious time to wait 3 hours for public service, he certainly deserved to be entertained even though he might not be living below the poverty line.

Special drugs supply options: It was agreed that HA should leave the supply of drugs to the free market and supply only drugs, which are not available or cannot be effectively supplied in the market. HA should focus its attention to in-patient care and leave the drug supply of outpatients to the free market. The option of inviting community pharmacies to operate in hospital premises is inadvisable. If patients can buy all drugs within the HA system, the community pharmacies will wither. Eventually, patients would have no choice but to totally rely on services provided by HA. This is against HA's declared policy of focusing the public medical services to the poor, to disasters and to the generally unaffordable hi-tech life-saving procedures. The hospital pharmacists held the same view that the pharmacy service in public hospitals should remain status quo and not to sell drugs so they can pay more attention to in-patient medication-related matters.

Other options: If HA were to let people with means to pay for their own drug bill in order to allocate more of its resources to the poor and the needy, they may consider a more revolutionary change - i.e. to subsidize the expensive drugs like some cancer drugs with no other alternative, that patients generally cannot afford, while those drugs with cheaper alternatives like some anti-hypertensive agents may be put on private-purchase list. Another way of rational use of resources is to ask all patients to be responsible for a certain amount of their own drug bill and let HA pay for excess. For instance, when the HA could no longer afford to distribute "statin" as primary preventive drug or "Fosamax®" as preventive treatment of osteoporosis, HA should make it clear that these drugs are excluded from the formulary because they are considered not cost-effectiveness and not ineffective. The community should be kept fully informed so that they may opt for seeking treatment from the private sector if they so wish.

In order not to create misunderstanding, HA should not evade the resource implication in the setting up of the formulary and grouping of drugs. It is therefore impossible to provide free medicine for all without a bottom line. HA must clearly define the role they played in the medical service market and prioritize the resources available to better serve the more needy groups in our community.

At the joint press conference with the pharmacists on 30 May 2006, HKMA was to reiterate our stance on HA’s Drug Formulary made last year. It’s not a reflex action whatsoever. If you care to read our press release which was made more than 15 months ago and available at our website since it was released, you would know that HKMA stand by its stance at all times.

As regards your comments on the practice of community pharmacists, we shall leave them to the practicing pharmacists.

Dr. CHEUNG Hon Ming
Honorary Secretary
The Hong Kong Medical Association

The expansion of SFI sales has been endorsed in an HA Board meeting.

Looks like it's high time we propose some amendments to the HA Ordinance.