Replies to LegCo questions
LCQ3: Hospital Authority Drug Formulary
Following is a question by the Dr Hon Helena Wong and a written reply by the
Secretary for Food and Health, Professor Sophia Chan, in the Legislative Council
today (November 8):
Question:
Under the existing requirements, applications for including new drugs in the
Hospital Authority Drug Formulary (HADF) (applications for new drug inclusion)
must be initiated by clinicians, endorsed by the heads of the clinical
departments to which such clinicians belong, and reviewed and recommended by the
Drug and Therapeutics Committees (DTCs) of the relevant hospital clusters or
hospitals, before they are vetted and approved by the Drug Advisory Committee
(DAC) under the Hospital Authority (HA). Upon approval of the applications for
new drug inclusion by DAC, the drugs concerned still have to await the decisions
of the relevant DTCs for their inclusion in the formularies of the hospitals
concerned before they may be used in the hospitals. On the other hand, the
Director of Audit pointed out in the Report No. 67 of the Director of Audit (the
Report), which was published on October 31 last year, that some public hospitals
had never made any application for new drug inclusion. Moreover, although 45
non-HADF drugs, which were used by public hospitals and clinics in 2015-16, had
been registered in Hong Kong and some of them were even in regular demand, no
application for new drug inclusion in respect of them had ever been made. The
Director of Audit also recommended that HA should continue to include
appropriate new self-financed drugs in the safety net of the Samaritan Fund
(safety net) to provide subsidy for patients with financial difficulties to
purchase drugs which are not covered by the standard fees and charges in public
hospitals and clinics. In this connection, will the Government inform this
Council if it knows:
(1) the number of applications for new drug inclusion received by DAC since the
publication of the Report;
(2) among the drugs approved by DAC in 2016-17 for inclusion in HADF, the number
of those which are now in use in the hospitals concerned and whether there are
drugs which have yet to be approved by the DTCs concerned for use in their
hospitals; if so, of the reasons for that; whether HA will consider publishing
annually a list of drugs approved by DAC for inclusion in HADF;
(3) whether HA will include the aforesaid 45 drugs in HADF as soon as possible,
so that patients of various public hospitals may be prescribed with such drugs;
(4) whether HA will conduct a study on streamlining the vetting and approval
procedure for applications for new drug inclusion so that new drugs will be
permitted to be used in public hospitals expeditiously;
(5) the number of meetings held by HA in each of the past three years on the
inclusion of new self-financed drugs in the safety net; whether HA will hold
such meetings more frequently, with a view to expeditiously increasing the
categories of subsidised drugs covered by the safety net; and
(6) the respective budgets and expenditures of various hospital clusters on
drugs in each of the past three years?
Reply:
President,
My reply to the question raised by Dr Hon Helena Wong on the Hospital Authority
Drug Formulary (HADF) is as follows:
(1) In the period from January to October 2017, a total of 71 applications for
new drug listing were received and handled by the Drug Advisory Committee (DAC)
under the Hospital Authority (HA).
(2) There are currently about 1 300 drugs listed on the HADF for treating a wide
range of diseases and providing adequate drug choices for different types of
hospitals to cater for the healthcare needs of the general public. Taking into
account the service provision of different hospitals and medical needs of
different patient groups, the Drug and Therapeutics Committees (DTCs) of
individual clusters/hospitals would select appropriate drugs from the HADF for
inclusion in the drug formularies of their hospitals. At present, non-acute and
convalescent hospitals as well as acute public hospitals (including major
hospitals providing quaternary services) have in general about 750 to 1 100
drugs in their drug formularies, which are adequate to meet their needs in daily
services and operation. Therefore, the drugs listed on the HADF have been
generally sufficient to satisfy the demands for public medical services. In
2016-17, 39 new drugs were added to the HADF, which have been included in the
drug formularies of different hospitals to meet the medical needs of their
service groups.
The DAC meetings are held quarterly to evaluate new drug applications for
listing on the HADF. The HA Head Office updates the HADF on its intranet and
internet websites quarterly to include new drugs and revisions to the HADF
approved under the established mechanisms. Moreover, the HA uploads the list of
new drugs to be reviewed at each DAC meeting to both its internet and intranet
websites, and sends the agenda of DAC meetings to the Alliance for Patients'
Mutual Help Organizations for further dissemination to its members. After each
DAC meeting, the outcome of each individual new drug application and a list of
references that have been taken into account in the process of considering each
application are uploaded to the HA's internet and intranet websites for the
reference of all healthcare professionals and the public.
(3) HADF drugs are intended for corporate-wide use to meet the healthcare needs
of the general public. However, the HA has also put in place a mechanism to
allow public hospital doctors to use non-HADF drugs (including drugs that
are/are not registered in Hong Kong) to cater for the clinical needs of
individual patients in urgent or exceptional circumstances. The 45 non-HADF
drugs used by the HA in 2015-16 mentioned in the Audit Report were all intended
to cater for the needs of individual patients in urgent or exceptional
circumstances. The DTCs of individual clusters/hospitals submit applications for
new drug listing taking into account the service provision of different
hospitals and medical needs of different patient groups. The DAC of the HA
carries out regular appraisal of new drugs under the established mechanism. New
drugs fulfilling the criteria and approved by the DAC will be included in the
HADF; and new drugs not fulfilling the criteria before may also be re-appraised
and included in the HADF after evolving of the drug over time. Some of the 45
drugs mentioned in the Audit Report have already been approved and included in
the HADF in accordance with the above procedures.
(4) Currently, DAC meetings are held quarterly to appraise all new drug
applications for listing. The appraisal of new drugs is an on-going process and
is driven by evolving medical evidence, latest clinical developments and market
dynamics. To speed up the appraisal process of new drugs, the HA has relaxed the
requirements for supporting documents in respect of new drugs that are in the
process of applying for registration by accepting the initial approval documents
issued by the Department of Health for preliminary evaluation.
(5) Upon receipt of proposals for including self-financed drugs in the safety
net of the Samaritan Fund (SF) and the Community Care Fund (CCF) Medical
Assistance Programmes, the Drug Management Committee (DMC) under the HA will,
after deliberation, submit the proposals to the relevant committees for final
approval and subsequent implementation. At present, the HA has regularised the
deliberations of the DMC twice a year, in a bid to include suitable
self-financed drugs in the SF safety net or the CCF Medical Assistance
Programmes as soon as possible. As at October 2017, 29 self-financed drugs were
covered by the SF safety net under the HA, and 17 self-financed drugs by the CCF
Medical Assistance Programmes for use by eligible patients. The HA will continue
to review the coverage of the safety net as appropriate according to the
established mechanisms.
(6) Every year, the HA will provide a block allocation to various hospital
clusters, which may flexibly deploy the funding and adjust their expenditures
having regard to the actual service demands. Hence, hospital clusters do not set
their annual budgets for drugs. The expenditures of various hospital clusters on
drugs in the past three years (i.e. 2014-15 to 2016-17) are set out in the
following table (note):
Year | Hong Kong East Cluster | Hong Kong West Cluster | Kowloon Central Cluster | Kowloon East Cluster | Kowloon West Cluster | New Territories East Cluster | New Territories West Cluster |
($ billion) | |||||||
2014-15 | 0.56 | 0.92 | 0.82 | 0.48 | 1.10 | 0.86 | 0.59 |
2015-16 | 0.57 | 1.00 | 0.87 | 0.51 | 1.16 | 0.95 | 0.65 |
2016-17 | 0.62 | 1.04 | 0.92 | 0.56 | 1.27 | 1.04 | 0.70 |
Note: Drug expenditures include items self-financed by patients.
Ends/Wednesday, November 8, 2017
Issued at HKT 16:55
NNNN