LEGISLATIVE COUNCIL ─ 23 May 2013 12245 OFFICIAL RECORD OF PROCEEDINGS Thursday, 23 May 2013 The Council continued to meet at Nine o'clock MEMBERS PRESENT: THE PRESIDENT THE HONOURABLE JASPER TSANG YOK-SING, G.B.S., J.P. THE HONOURABLE ALBERT HO CHUN-YAN THE HONOURABLE JAMES TO KUN-SUN THE HONOURABLE CHAN KAM-LAM, S.B.S., J.P. DR THE HONOURABLE LAU WONG-FAT, G.B.M., G.B.S., J.P. THE HONOURABLE EMILY LAU WAI-HING, J.P. THE HONOURABLE TAM YIU-CHUNG, G.B.S., J.P. THE HONOURABLE ABRAHAM SHEK LAI-HIM, S.B.S., J.P. THE HONOURABLE TOMMY CHEUNG YU-YAN, S.B.S., J.P. THE HONOURABLE FREDERICK FUNG KIN-KEE, S.B.S., J.P. THE HONOURABLE WONG KWOK-HING, M.H. DR THE HONOURABLE JOSEPH LEE KOK-LONG, S.B.S., J.P. THE HONOURABLE JEFFREY LAM KIN-FUNG, G.B.S., J.P. THE HONOURABLE ANDREW LEUNG KWAN-YUEN, G.B.S., J.P. THE HONOURABLE WONG TING-KWONG, S.B.S., J.P. 12246 LEGISLATIVE COUNCIL ─ 23 May 2013 THE HONOURABLE RONNY TONG KA-WAH, S.C. THE HONOURABLE CYD HO SAU-LAN THE HONOURABLE STARRY LEE WAI-KING, J.P. DR THE HONOURABLE LAM TAI-FAI, S.B.S., J.P. THE HONOURABLE CHAN HAK-KAN, J.P. THE HONOURABLE CHAN KIN-POR, B.B.S., J.P. DR THE HONOURABLE PRISCILLA LEUNG MEI-FUN, J.P. DR THE HONOURABLE LEUNG KA-LAU THE HONOURABLE CHEUNG KWOK-CHE THE HONOURABLE WONG KWOK-KIN, B.B.S. THE HONOURABLE IP KWOK-HIM, G.B.S., J.P. THE HONOURABLE MRS REGINA IP LAU SUK-YEE, G.B.S., J.P. THE HONOURABLE PAUL TSE WAI-CHUN, J.P. THE HONOURABLE ALAN LEONG KAH-KIT, S.C. THE HONOURABLE LEUNG KWOK-HUNG THE HONOURABLE ALBERT CHAN WAI-YIP THE HONOURABLE WONG YUK-MAN THE HONOURABLE CLAUDIA MO THE HONOURABLE MICHAEL TIEN PUK-SUN, B.B.S., J.P. THE HONOURABLE JAMES TIEN PEI-CHUN, G.B.S., J.P. THE HONOURABLE NG LEUNG-SING, S.B.S., J.P. LEGISLATIVE COUNCIL ─ 23 May 2013 12247 THE HONOURABLE FRANKIE YICK CHI-MING THE HONOURABLE WU CHI-WAI, M.H. THE HONOURABLE YIU SI-WING THE HONOURABLE GARY FAN KWOK-WAI THE HONOURABLE MA FUNG-KWOK, S.B.S., J.P. THE HONOURABLE CHARLES PETER MOK THE HONOURABLE CHAN CHI-CHUEN THE HONOURABLE CHAN HAN-PAN DR THE HONOURABLE KENNETH CHAN KA-LOK THE HONOURABLE CHAN YUEN-HAN, S.B.S., J.P. THE HONOURABLE KENNETH LEUNG THE HONOURABLE ALICE MAK MEI-KUEN, J.P. DR THE HONOURABLE KWOK KA-KI THE HONOURABLE KWOK WAI-KEUNG THE HONOURABLE DENNIS KWOK THE HONOURABLE CHRISTOPHER CHEUNG WAH-FUNG, J.P. DR THE HONOURABLE FERNANDO CHEUNG CHIU-HUNG DR THE HONOURABLE HELENA WONG PIK-WAN THE HONOURABLE IP KIN-YUEN DR THE HONOURABLE ELIZABETH QUAT, J.P. THE HONOURABLE MARTIN LIAO CHEUNG-KONG, J.P. 12248 LEGISLATIVE COUNCIL ─ 23 May 2013 THE HONOURABLE POON SIU-PING, B.B.S., M.H. THE HONOURABLE TANG KA-PIU DR THE HONOURABLE CHIANG LAI-WAN, J.P. IR DR THE HONOURABLE LO WAI-KWOK, B.B.S., M.H., J.P. THE HONOURABLE CHUNG KWOK-PAN THE HONOURABLE CHRISTOPHER CHUNG SHU-KUN, B.B.S., M.H., J.P. THE HONOURABLE TONY TSE WAI-CHUEN MEMBERS ABSENT: THE HONOURABLE LEE CHEUK-YAN THE HONOURABLE LEUNG YIU-CHUNG THE HONOURABLE VINCENT FANG KANG, S.B.S., J.P. THE HONOURABLE STEVEN HO CHUN-YIN THE HONOURABLE LEUNG CHE-CHEUNG, B.B.S., M.H., J.P. THE HONOURABLE SIN CHUNG-KAI, S.B.S., J.P. PUBLIC OFFICERS ATTENDING: THE HONOURABLE GREGORY SO KAM-LEUNG, G.B.S., J.P. SECRETARY FOR COMMERCE AND ECONOMIC DEVELOPMENT DR THE HONOURABLE KO WING-MAN, B.B.S., J.P. SECRETARY FOR FOOD AND HEALTH LEGISLATIVE COUNCIL ─ 23 May 2013 12249 CLERKS IN ATTENDANCE: MR ANDY LAU KWOK-CHEONG, ASSISTANT SECRETARY GENERAL MISS FLORA TAI YIN-PING, ASSISTANT SECRETARY GENERAL MISS ODELIA LEUNG HING-YEE, ASSISTANT SECRETARY GENERAL MRS PERCY MA, ASSISTANT SECRETARY GENERAL 12250 LEGISLATIVE COUNCIL ─ 23 May 2013 MEMBERS' MOTIONS PRESIDENT (in Cantonese): Members' motions. Two motions with no legislative effect. I have accepted the recommendations of the House Committee: that is, the movers of motions each may speak, including reply, for up to 15 minutes; movers of the first and second motions have another five minutes to speak on the amendments; the movers of amendments to a motion each may speak for up to 10 minutes; the mover of amendment to amendment may speak for up to seven minutes; and other Members each may speak for up to seven minutes. I am obliged to direct any Member speaking in excess of the specified time to discontinue. First Member's motion: Drug Formulary and drugs subsidy system. Members who wish to speak in the motion debate will please press the "Request to speak" button. I now call upon Miss Alice MAK to speak and move the motion. (Originally scheduled to be dealt with at the last Council meeting) DRUG FORMULARY AND DRUGS SUBSIDY SYSTEM MISS ALICE MAK (in Cantonese): President, I move that the motion, as printed on the Agenda, be passed. President, the Drug Formulary (the Formulary) is a subject mentioned by the Chief Executive and the Financial Secretary respectively in this year's Policy Address and Budget ― a sign that the authorities are also aware of the existing problems with the Formulary. The Hospital Authority (HA) has implemented the Formulary system since July 2005 with the good intention of standardizing its policies on procurement and use of drugs to ensure equitable access to prescription drugs by patients. At present, there are about 1 300 drugs in the Formulary, of which 75% are General Drugs and 25% are Special Drugs. General Drugs are available for general use by doctors of public hospitals and clinics, while Special Drugs have to be used under specified clinical conditions with authorization by relevant specialist doctors. These drugs are provided to patients at a standard charge of $10 per drug item. LEGISLATIVE COUNCIL ─ 23 May 2013 12251 We agree that after the implementation of the Formulary system, the introduction of new drugs by the HA has become more systematic and objective, and the use of drugs in different hospitals has been standardized, which is beneficial to patients to a certain extent. For instance, in the past, some drugs might be available in some hospital clusters and not in others, but after the implementation of the Formulary, all hospital clusters can supposedly prescribe the drugs included in the Formulary to patients. Nonetheless, we find that after the implementation of the Formulary, there are still patients suffering delays in treatment due to their inability to afford better drugs, having to sell their properties in order to purchase drugs, or relying on lower-quality drugs to extend their lives. This reflects the existence of many inadequacies in the existing system which cannot provide people with the most suitable protection. At present, the HA has two committees responsible for work in relation to the Formulary, namely, the Drug Advisory Committee (DAC) which is tasked with appraising new drugs for inclusion in the Formulary, and the Drug Utilization Review Committee which is responsible for reviewing the existing drugs in the Formulary periodically. The DAC comprising doctors, clinical pharmacologists and pharmacists, appraises new drugs every three months. But the DAC's composition has all along been criticized as under-representation for there is no member to represent other stakeholders, such as patients' organizations, giving rise to the feeling that the views and rights of patients have not been duly considered. Apart from its composition, the DAC has also been criticized for failing to disclose in detail the process and contents of discussions at its meetings. Only the agenda, review outcome and drug references list for each meeting are available in the HA's website. Members of the public only know which drugs have been appraised and what is the final outcome as the discussion process has not been disclosed, for example, what factors have been considered by the members in making their decisions, whether their rationale is justified, whether assessment has been made from the patients' perspective? There is no way we can find out the answers to these questions, which is why the DAC has been criticized for operating in a black box. Although a consultation mechanism with patient groups on the Formulary has been established by the HA since 2009, this so-called mechanism in fact only entails holding an annual consultation meeting to inform patients of the latest 12252 LEGISLATIVE COUNCIL ─ 23 May 2013 developments of the Formulary and the Samaritan Fund, and solicit their views. The entire process is about relaying all the decisions made by the HA to the patients, and then seeking their views. What kind of consultation is that? We opine that the HA should reform the DAC to at least include representatives of stakeholders like patients' organizations, so that they can truly participate in the discussion and decision-making process, instead of the HA consulting patients as a formality after making all the decisions. Moreover, the authorities should make public the records of meetings of the DAC, so that people know clearly the standards and rationale adopted by members in making their decisions, which helps increase the transparency of the entire decision-making process. Let me give a simple example. At present, many drugs, especially those proven to be of significant efficacy but are expensive, can only be included in the category of Self-financed Items (SFIs) with safety net, causing doubts and concerns of many patients as to whether cost-effectiveness is the most important factor considered by the DAC.