Replies to LegCo questions
LCQ3: Drug policy
Following is a question by the Dr Hon Kwok Ka-ki and a written reply by the
Secretary for Food and Health, Dr Ko Wing-man, in the Legislative Council today
(May 20):
Question:
The Hospital Authority (HA) has implemented the Drug Formulary (Formulary) since
2005 with a view to ensuring equitable access by patients to cost-effective
drugs of proven efficacy and safety through standardisation of policies on drugs
and drug utilisation. Drugs in the Formulary are categorised into General Drugs,
Special Drugs and Self-financed Drugs (SFDs). Drugs in the first two categories
are subsidised by public funds while those in the last category need to be
purchased by patients at their own expense. A patient group has pointed out that
14 new cancer drugs were registered in Hong Kong in the past two years, but they
have not been incorporated by HA into the list of SFDs on the grounds that
"there is no sufficient evidence to prove the cost-effectiveness of the drugs".
This patient group has also pointed out that since many new target therapy drugs
for cancers have not been incorporated by HA into the list of SFDs, healthcare
personnel in public hospitals generally will not take the initiative to provide
patients with information about such drugs, thus undermining patients' right to
know. In this connection, will the Government inform this Council if it knows:
(1) regarding the new drugs that came onto the market in the past five years, (i)
the average length of time between registration in Hong Kong and incorporation
by HA into the Formulary, and
(ii) the percentage of drugs that were not incorporated into the Formulary and
the reasons for that;
(2) the specific criteria currently adopted by HA when considering the
incorporation or otherwise of new drugs into the list of SFDs; the standards
adopted by HA for determining the cost-effectiveness of new drugs;
(3) whether the Drug Advisory Committee (DAC) of HA will adopt measures (such as
increasing the frequency of meetings) to speed up the process of vetting and
approval of new drugs, with a view to keeping pace with the rapid development of
healthcare technology; if DAC will, of the details; whether HA has considered
expanding the membership of DAC and inviting stakeholders from various sectors
(including representatives from patient groups) to join, so as to enhance the
transparency of DAC's work; and
(4) whether HA will conduct a comprehensive review of the Formulary system; if
HA will, of the details and specific timetable; whether HA will consider issuing
guidelines to healthcare personnel requiring them to provide patients with
comprehensive information about drugs outside the Formulary (especially target
therapy drugs for cancers that are of greater concern to patients); if HA will,
of the details; if not, the reasons for that?
Reply:
President,
The Hospital Authority (HA) Drug Formulary (Formulary) was implemented in July
2005 with a view to ensuring equitable access by patients to cost-effective
drugs of proven safety and efficacy by standardising the drug utilisation and
drug policy in the HA. At present, there are four categories of drugs in the
Formulary:
i) General drugs: drugs with well-established indications and cost-effectiveness
which are available for general use as indicated by patients with relevant
clinical conditions. These drugs are provided at standard fees and charges in
public hospitals and clinics;
ii) Special drugs: drugs which are used under specific clinical conditions with
specific specialist authorisation. These drugs are provided at standard fees and
charges in public hospitals and clinics when prescribed under specific
conditions. Patients who do not meet the specified clinical conditions but
choose to use special drugs have to pay for the drugs;
iii) Self-financed drugs with safety net: drugs which are proven to be of
significant benefits but extremely expensive for the HA to provide as part of
its standard services. These drugs are not covered by the standard fees and
charges in public hospitals and clinics. Patients who need these drugs and can
afford the costs have to purchase the drugs at their own expense. However, a
safety net is provided through the Samaritan Fund to subsidise the drug expenses
of patients who need the drugs but have financial difficulties; and
iv) Self-financed drugs without safety net: including drugs with preliminary
medical evidence only, drugs with marginal benefits over available alternatives
but at significantly higher costs, and lifestyle drugs (e.g. weight-loss drugs).
These drugs are not provided at standard fees and charges. Patients have to
purchase these drugs at their own expense.
My reply to the various parts of the question is as follows:
(1) and (2) The HA has put in place a mechanism to regularly appraise new drugs
and review the prevailing drug list in the Formulary with the support of 20
expert panels. Under the current mechanism, the Drug Advisory Committee (DAC) of
the HA appraises new drugs regularly and determines whether a drug and its
clinical use should be included in the Formulary. Nevertheless, the DAC does not
automatically appraise all new drugs registered in Hong Kong. Clinicians would,
in accordance with service needs, submit applications for drug appraisal to the
DAC.
Since appraisal of new drugs is an on-going process and is driven by evolving
medical evidence, latest clinical developments and market dynamics, the HA has
no record on the average length of time between registration of new drugs in
Hong Kong and their inclusion in the Formulary; and has no statistics on the
percentage of drugs that are not included in the Formulary.
Cost-effectiveness is only one of the factors taken into account by the HA when
considering whether a specific drug should be included in the Formulary. In
appraising a new drug, the HA experts adopt an evidence-based approach and
specific clinical criteria, follow principles of safety, efficacy and
cost-effectiveness, and take into account various factors, including
international recommendations and practices, technological changes,
pharmacological class, disease state, medication compliance and quality of life
of patients, practical experience in the use of drugs, comparison with available
alternatives, impacts on healthcare costs, views of professionals and patients
groups, etc.
The HA will introduce appropriate drugs in the light of its service development
and operational needs so as to ensure equitable access by patients to
cost-effective drugs of proven safety and efficacy.
(3) The DAC of the HA conducts meeting once every three months to appraise new
drugs. There is no limit on the number of new drug applications for each meeting
and the DAC has so far been able to complete all new drug appraisals as
scheduled. Therefore, the HA has no plan to increase the frequency of DAC
meetings at present.
The HA is cognisant of the strong expectation of the public and patient groups
for enhancing the transparency of the Formulary and increasing patient
involvement. The HA maintains close communication with patient groups on the
Formulary through established liaison channels. Stakeholder engagement and
communication channels have been formalised to ensure proper consultation and
appropriate participation of stakeholders and service partners.
To enhance accountability and partnership with the community, HA convenes two
consultation meetings with patient groups every year to keep them abreast of the
latest developments of the Formulary, gather their views on the introduction of
new drugs and review of the existing drug list in the Formulary. Patient groups
are invited to attend meetings and submit their views and proposals to the HA
for reference and consideration by relevant drug committees. With the
establishment of the Patient Advisory Committee in early 2011, the Chief
Executive of the HA meets patient representatives regularly to collect their
views on various areas of patient services, including matters related to the
Formulary. Ad hoc meetings are also convened with individual patient groups to
discuss specific issues of concerns where necessary.
To enhance the transparency of the decision-making process for including new
drugs in the Formulary and improve the communication with patient groups, the HA
would upload to its intranet and the internet websites the professional
composition of the DAC, the drug lists discussed at each DAC meeting, the review
outcome of each application and the reference materials used in new drug
appraisals for stakeholders' reference.
In view that enlisting representatives of patient groups in the DAC may give
rise to conflicts of interest and hinder the objective discussion and expression
of views by experts, the HA does not consider it appropriate to include
representatives of patient groups in the DAC. Nevertheless, the HA will continue
to consult patient groups on the Formulary through established liaison channels
to ensure their participation.
(4) As a publicly-funded healthcare organisation, the HA has to ensure rational
use of public resources so as to protect public health and patients' interest.
Under the current mechanism, in addition to the DAC that appraises new drugs
regularly, the HA Drug Formulary Committee is responsible for regular review of
the prevailing drug list in the Formulary. General drugs that have become
obsolete and are no longer required or used will be removed from the Formulary,
while the clinical indications of individual Special drugs may be modified as
appropriate.
Since its implementation in July 2005, the Formulary mechanism has been
operating effectively and has become an important cornerstone of drug therapies
in the public health sector. To cope with the continuous rapid advancement in
medical technology, the Formulary is regularly updated. Apart from putting the
drug policy of Hong Kong in line with international developments, this mechanism
also ensures that new drugs are continuously introduced to the public healthcare
system. The HA will keep on reviewing the Formulary in accordance with the
principle of rational use of limited public resources to benefit more patients
and with reference to the latest developments in clinical research and
scientific evidence.
At present, there are different drugs in the Formulary for treatment of various
diseases. Specialists would prescribe appropriate drugs and provide necessary
treatments for patients, having regard to their clinical needs and in accordance
with the established treatment guidelines.
Ends/Wednesday, May 20, 2015
Issued at HKT 15:27
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