Hospital Formularies Decision-Making Process a CADTH Environmental Scan

1. Hospital Formularies Decision-Making Processa CADTH Environmental Scan Kathleen Kulyk Liaison Officer – Saskatchewan on behalf of Sirjana Pant 2015 CADTH Symposium April 13, 2015

2. Background Pharmacy and Therapeutics Committees function at various levels to make formulary decisions Independent process resulting in variations in formularies More collaboration in recent years to enhance continuity of care, ensure equality of services, and improve the ability to align the hospital formulary with the publicly funded provincial outpatient drug program

3. Introduction Survey-based Environmental Scan Level of awareness and use of CADTH products and services at Canadian health authorities and hospitals. Identify potential opportunities for CADTH to support formulary review processes at Canadian health authorities and hospitals Explore the level of collaboration between these health authorities and hospitals and the public drug plans when formulary decisions are being made. Pant S, Sherwood V, and Chelak K. Hospital Formularies Decision-Making Process. Ottawa: Canadian Agency for Drugs and Technologies in Health; 2015. www.cadth.ca

4. Method 23 surveyed, responses received from 20 (June - October , 2014) Currently involved in a health authority or hospital formulary decision-making process (except Quebec) – Total 19 respondents in findings Representation from each province and territory. Representation from both urban and rural settings in all the provinces (except Nova Scotia) All respondents from the territories represented institutions servicing remote locations. Two respondents were located in urban centres but provided support for remote locations (Nunavut and rural Ontario) via telepharmacy

5. Survey Questions on Collaboration Describe any ongoing initiatives your institution may be initiating or exploring to better support your drug review process? How do provincial drug plan formulary decisions influence your drug formulary decisions? Are there any formal policies or informal processes in place and/or any initiatives underway to align with provincial drug plan recommendations?  What challenges have been identified in your jurisdiction to align hospital formularies with provincial drug plan formularies?

6. Limitations Not a comprehensive review Do not represent perspective of public drug plans Perspective of health authorities and/or hospitals only Small sample size Identify potential trends Possible explanations around existing variations Encourage further discussion

7. Findings

8. Level of Collaboration between Hospitals and HAs in a province/territory Public Drug Plan, and HAs and Hospitals in a province/ territory

9. Out of the 19 respondents, . recommendations.

12. Challenges in Aligning Hospital Formularies With Provincial Drug Plan Formularies

13. Challenges Role in the Health Care System Perception of public drug plans solely as the funders Factors Affecting the Overall Cost of Drug cost of managing an illness and hospital contract cost Decision-Making Process Factors influencing decision making. Limit hospital formulary listings to guide best practices. Viewpoints on who should influence decision making

14. Challenges Implementation and Resources Implementation of new medications, Inventory issues and aligning with federal and provincial plan. Product Type Different therapeutic considerations; access to emerging treatment (tertiary care centers); hospital formulary more restrictive in general. Additional Issues Lack of resources to support a single equitable process Variation in local implementation

15. Conclusion Various ongoing (formal/informal) efforts establishing a single committee to make formulary decisions for both public drug plans and hospitals in a province, establishing a single provincial hospital formulary, establishing provincial-level working groups or advisory committees, re-evaluating the role of the P&TC, and/or sharing drug reviews between institutions.

16. Conclusion Hospitals and HAs consider public drug plan coverage. Challenges in aligning with the public drug plan due to differences in the roles of these institutions in the health care system, factors affecting the overall cost of adding a drug to a formulary, decision-making processes, implementation and resources issues, product types.