Formularies

Question 1

What is a drug formulary?

Answer 1

a list of medications that are covered by a health plan

Question 2

What are some examples of formularies?

Answer 2

SPDP
SK Cancer Agency
Hospital Benefit Drug List
Federal formularies (NIHB, RCMP, etc)
Third party payers

Question 3

What is a formulary system?

Answer 3

the ongoing process through which an organization identifies medications that are most medically appropriate & cost-effective to best serve the health interests of a given patient population

Question 4

What are the objectives of a formulary system?

Answer 4

optimize appropriate drug therapy
reduce drug costs

Question 5

Describe formulary system management.

Answer 5

1. generics/biosimilars
2. dispensing frequency
3. drug use criteria (EDS)
4. treatment guidelines
5. therapeutic substitution/interchange
6. others: maximum allowable cost, trial Rx, MS drugs

Question 6

What are the advantages and disadvantages of drug use criteria on formularies?

Answer 6

advantages:
-ensure proper utilization of therapies
-cost containment
disadvantages:
-administratively cumbersome
-relies on many people doing their part

Question 7

Can people still get drugs not listed on the formulary?

Answer 7

yes
have to pay out of pocket

Question 8

What is health technology assessment?

Answer 8

the systematic evaluation of the properties, effects and/or impacts of a health technology, and aimed mainly at informed decision making regarding health technologies
a multidisciplinary process to evaluate the social, economic, organizational and ethical issues of a health intervention/technology

Question 9

What is CADTH?

Answer 9

Canadian Agency for Drugs and Technologies in Health
-responsible for performing HTAs for publicly funded healthcare providers
-allows decision makers to make evidence based health policy decisions
-could be related to drugs, medical devices, and procedures
funded by the federal gov and provincial health ministries

Question 10

What is the Common Drug Review Program?

Answer 10

a pan-Canadian process for conducting objective, rigorous reviews of the clinical, cost-effectiveness, and patient evidence for drugs
provides formulary listing recommendations to Canadas publicly funded drug plans (except Quebec)

Question 11

What is PCODR?

Answer 11

Pan Canadian Oncology Drug Review
-an evidence based, cancer drug review process
-brings consistency and clarity to the assessment of cancer drugs by reviewing evidence, cost-effectiveness, and patient perspectives to make recommendations to provinces (except Quebec) in guiding their drug funding decisions

Question 12

What is CDEC?

Answer 12

Canadian Drug Expert Committee
-15 members (11 Rx/MD, 3 public members, 1 ethicist, plus ad hoc blood services expert)
-meet monthly
-make recommendations on drugs and therapeutic reviews to the participating jurisdictions

Question 13

What are the considerations for CDEC recommendations?

Answer 13

1st: is there clinical benefit?
2nd: patient submission
3rd: is it cost effective?

Question 14

What are the CDEC recommendations?

Answer 14

reimburse
reimburse with conditions
do not reimburse

Question 15

What is pCPA?

Answer 15

pan-Canadian Pharmaceutical Alliance
-achieve greater value for publicly funded drug programs and patients through negotiating power of participating jurisdictions
-once a recommendation comes from CADTH or INESSS, pCPA uses the recommendations to decide to enter into negotiations or not with the manufacturer

Question 16

What does the pCPA aim to do?

Answer 16

achieve lower drug costs and consistent pricing
increase access to drug treatment options
improve consistency of coverage criteria across Canada

Question 17

What are the ways that formulary additions to the provincial drug plan happen?

Answer 17

1. CDR review of new product
2. manufacturer submission
3. request from health care professionals
4. request from patient groups
5. ministry or provincial priority

Question 18

What is DACS?

Answer 18

Drug Advisory Committee of Saskatchewan
-members: pharmacy, medicine, public members

Question 19

What is the goal of DACS?

Answer 19

to provide independent specialized advice on drug-related matters

Question 20

What are the duties/responsibilities of DACS?

Answer 20

evaluate drug products based on clinical evidence and cost effectiveness data to provide advice to the minister regarding appropriate drug utilization and drug use optimization

Question 21

What is DTC?

Answer 21

Drug and Therapeutic Committee
-meet 7-9 times per year to manage the hospital formulary
-30 voting members co-chaired by a pharmacist and physician
-have the authority to approve formulary requests up to a certain dollar amount, as well as a process for non-formulary drugs

Question 22

How do drugs find themselves off the formulary?

Answer 22

new evidence
discontinued by manufacturer & no alternative available
safety issues
nil to very low usage/need
result of a therapeutic class review