Alberta Pharmaceutical Strategy: Stakeholder Consultation

Alberta Pharmaceutical STRATEGY Stakeholder Consultation September 2008 Jonathan Denis, MLA, Calgary-Egmont Submitted to Honourable Ron Liepert Minister Alberta Health and Wellness Background and Summary of Recommended Consultation Process: Actions from Stakeholders: Alberta Health and Wellness Minister 1) Focus on the patient Ron Liepert announced the creation of a Health • Support should be provided for wellness Action Plan for Alberta in April 2008. A key initiatives to avoid prescription drug use in the component of this plan is the development first place; however, when required, drug therapy of a pharmaceutical strategy. may provide a cost effective benefit to patients. In order to obtain stakeholder input into • Appropriate drug therapy typically results in the strategy, Minister Liepert requested that increased life expectancy, quality of life and Jonathan Denis, MLA for Calgary-Egmont, productivity, and decreased reliance on other meet with key stakeholders, summarize their more expensive aspects of the health care system. comments, and make key recommendations. • Alberta Health and Wellness should empower The terms of reference for the consultation patients to be informed and active participants and the individuals and groups represented in wellness and health care choices. are listed as attachments. From July 1, 2008 to August 8, 2008, 2) Ensure access to therapy while Mr. Denis held meetings with 16 stakeholder requiring fair and equitable groups representing patients, physicians, patient contributions pharmacists, employers, benefit providers, • Barriers with existing programs include and the pharmaceutical industry. To start each without limitation: discussion, Mr. Denis posed a single question - cost – “What direction do you believe government - gaps in drug benefit listings should be taking for a pharmaceutical strategy - delays in granting access to new therapies and why?” Discussion and further questions - lack of funding for complementary and from both sides followed. All groups were alternative medicines (CAM) within programs also given the option of providing a written • Ensure consolidation of government plans and submission by August 8, 2008 to clarify consistency across said plans. and supplement the discussion. In addition to written submissions resulting from the • The naming of government benefit plans as meetings, input was received from four other “Alberta Blue Cross” plans causes confusion interested parties. as there are many public and privately funded Alberta Blue Cross drug plans. • Stakeholders recognize that program mechanisms should ensure cost sharing among individuals, employers and government. 3 • A provincial strategy should be instituted to Recommendation Two: ensure catastrophic drug coverage is available as cost should not be a barrier to access to There are times when patients do not necessary therapies. tolerate or benefit from therapies available on the drug benefit list. These patients may • Prioritize protection to ensure coverage benefit from treatment with other drugs. is available for lower income Albertans. For this group of patients, it is recommended • Implement an independent consideration that a process for independent consideration process for specific patients including approval be established. This process should involve of drugs for non-approved indications. the individual’s physician and pharmacist. A request and review process that considers anticipated benefit and outcomes, risk and Recommendation One: cost of therapy should be established. Currently, the Government of Alberta delivers drug benefits through five separate Recommendation Three: agencies: Alberta Health and Wellness, Children and Youth Services, Employment Mandate full disclosure of all cost components and Immigration, Seniors and Community of a prescription on the receipt (drug Supports and Solicitor General and Public cost to government or private insurance, Security. It is recommended that the drug drug cost to patient, and dispensing fee) benefit programs offered by these agencies to ensure patients are aware of their own be consolidated into a single consistent contributions and the contributions of program administered by one authority. employers and government to their care so The program should support access to patients are better able to evaluate the value appropriate and necessary therapies, while of the service provided. This will also create cost sharing fairly with individuals and additional competition between pharmacies employers where applicable. This new and keep dispensing fees at a continually program should be promoted and recognized reasonable level. as a Government of Alberta program. 4 3) Hold the program participants Recommendation Four: accountable and ensure transparent processes Create transparent reporting for drug coverage decisions, a detailed rationale for are implemented the same being made available to the public. • There should be strict conflict of interest Those involved in creating the listing guidelines for care providers supporting recommendations should abide by strict patients to manage their health. conflict of interest guidelines, established • Adopt guidelines on appropriate health care and maintained with input from the Ethics provider - pharmaceutical industry relations Commissioner. to limit impact of industry on influencing prescribing. Recommendation Five: • There should be effective dialogue and appeal mechanisms for all decisions. Develop an enhanced drug review and • Restructure the Expert Committee with listing process with improved stakeholder a view to the following: engagement and structured appeal mechanisms. Patients, prescribers, - meaningful consumer participation, pharmacists, and industry should have an - meaningful disease expert participation, opportunity to provide input into drug listing - open and transparent discussion, and recommendations. The review process should - accountability for decisions made. consider and base recommendations on • Add public members to the decision process clinical and therapeutic evidence, cost and to create an equitable balance between medical benefit of therapy, and societal, ethical and expert and social value in decisions. equity perspectives. • To be most effective, the role and expectations of public input into the drug benefit listing process must be well defined. • Establish continual performance measures, transparency checkpoints, and appeal mechanisms. • A key future component of the program should be the establishment and monitoring of measures of patient outcomes of therapy. • Use the Health Quality Council of Alberta (HQCA) quality matrix as a tool to evaluate the impact of system change. 5 4) Streamline drug program Recommendation Six: processes Make timely drug coverage decisions • Alberta Health and Wellness should work Establish a structured timeline for review towards harmonization/alignment of hospital and recommendation that is publicly and community based formularies to support available so any individual may follow a drug continuity of care and minimal disruption of through the review process. Listing approval therapy as patients receive care. of multisource (generic) products should • There should be a consistent approach occur within 30 days in order to reduce costs and process to review and list drugs across by providing more timely access to newly all categories (community, province-wide marketed generic drugs. Listing for new services, cancer). patented medicines should occur within • Maintain transparency and list all benefits. 120 days of Notice of Compliance or Common Drug Review recommendation to provide • Review the federal proposal of interchangeability access to new and valued therapies. included in the progressive licensing structure. Adopt as appropriate to support a shortening of listing times. Recommendation Seven: • Streamline the special authorization process – a lack of availability of family physicians Reduce the administrative burden on health within the province is believed to result in this care professionals through evaluation, program being a barrier to medication access. restructuring and simplification of the special authorization policies and processes. • Allow pharmacists to submit applications for special authorization medications. 6 5) Maintain a system-wide • Align the system with desired behaviors and perspective when considering reward strategies that attain those behaviors. drug costs and approaching • To shift practice, rewards to pharmacists health care budgeting must be considered in addition to pharmacy • Shift the focus from cost to value of rewards. pharmaceuticals in full context of health • Respect the complexity of the supply chain, expenditures. Drug therapies benefit evolution of systems and how competition individuals by allowing them to maintain has created efficient logistics processes. health and functioning and to avoid reliance • A single federal system would benefit on other aspects of health and social services. all payers and establish an ability to set • Drug benefit costs represent 70-80 per cent of prices (example: Australia). The National the total benefit plan costs borne by employers. Pharmaceutical Strategy and tenets are Accordingly, the focus of the pharmaceutical still valid – a multi-jurisdictional approach is strategy must be on the whole economy of required to attain savings that may be redirected pharmacy - not just the portion funded by to allow access to new, expensive therapies. government. • Capitalize

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