LCQ3: Hospital Authority Drug Formulary
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?
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|
Note: Drug expenditures include items self-financed by patients.
Ends/Wednesday, November 8, 2017
Issued at HKT 16:55
Issued at HKT 16:55