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LCQ3: Hospital Authority Drug Formulary

     Following is a question by the Hon Wong Sing-chi and a reply by the Secretary for Food and Health, Dr York Chow, in the Legislative Council today (October 20):


     The Hospital Authority (HA) has implemented the Drug Formulary by phases since 2005 under which two categories of drugs need to be purchased by patients at their own expenses. One category which comprises drugs proved to be of significant benefits is provided with a safety net, whereby patients may be partially or fully subsidised for their drug expenses through the Samaritan Fund after passing the household income test. The other category is not provided with a safety net and some drugs necessary for the treatment of cancers belong to this category.  Furthermore, in the second stage public consultation document on healthcare reform published this month, the authorities have proposed that a commitment of $50 billion be made to encourage sustained public participation in the Health Protection Scheme (HPS). In this connection, will the Government inform this Council:

(a) whether it knows the number of patients who were subsidised through the Samaritan Fund for drug purchases in the past 12 months, as well as the respective amounts subsidised and paid by themselves; of the number of types of drugs for treating cancers under the self-financed items without safety net, as well as the number of patients who purchased these drugs at their own expenses and the amount of drug expenses incurred;

(b) of the principle based on which the authorities refuse to pay for patients' drug expenses and require patients to self-finance expensive drugs on the ground of insufficient resources on the one hand but propose on the other hand the use of public money and resources to subsidise members of the public to take out private-run medical insurance from insurance companies in order to obtain services which are better than those offered by the public healthcare system; whether HPS will benefit patients who need to purchase expensive drugs at their own expenses at present; if so, of the details; and

(c) given that the revenue from land sales for the Government has increased substantially this year, and the Democratic Party has proposed the Government to allocate $10 billion to establish a Medicines Subsidy Fund, from which the investment income each year will be allocated to HA to increase its financial commitment for drug expenses, whether the authorities have studied the proposal; if they have, of the outcome of the study; if not, the reasons for that?



     The Drug Formulary (the Formulary) has been implemented by the Hospital Authority (HA) in public hospitals and clinics since 2005. The objective is to ensure equitable access by patients to cost-effective drugs of proven safety and efficacy through standardisation of the drug policy and drug utilisation in all HA hospitals and clinics. The Formulary is developed after evaluation of new drugs and review of the current list of drugs in the Formulary by the relevant experts on a regular basis. The review process is based on the scientific and clinical evidence on the safety, efficacy and cost-effectiveness of the drugs, and views of patient groups will also be taken into account. Changes to the Formulary will be made as appropriate.

     At present, there are about 1,300 standard drugs in the Formulary. They can be classified into two categories, namely general drugs and special drugs. General drugs constitute around 80% of all standard drugs. These drugs have well-established clinical indications, efficacy and cost-effectiveness, and are available for general use by doctors of public hospitals and clinics. The remaining 20% of all standard drugs are special drugs. These drugs have to be used under specified clinical conditions with authorisation by relevant specialist doctors. HA charges standard fees and charges for general and special drugs when prescribed under the above conditions.

     For patients who do not meet the specified clinical conditions but choose to use special drugs in the Formulary, they would have to pay for the drugs as self-financed items. Also, patients have to purchase those drugs which are not standard drugs in the Formulary at their own expenses. However, for drugs which are proven to be of significant benefits but are not included in the Formulary as standard drugs having regard to the considerations of the overall cost-effectiveness, we provide a safety net through the Samaritan Fund to subsidise the drug expenses of patients with clinical conditions requiring the use of these drugs but have financial difficulties. Currently, drugs not covered by the safety net only include (1) drugs which have preliminary medical evidence only; (2) drugs with marginal benefits over available alternatives but at significantly higher costs; and (3) life-style related drugs which are not medically necessary (e.g. weight-loss drugs).  

     The reply to various parts of the question is as follows:

(a) The current Formulary has included many effective drugs for the treatment of various diseases.  These drugs, including a number of expensive drugs for treating cancer and various acute and chronic diseases, are provided to patients at standard fees and charges.

     In recent years, HA has been expanding the coverage of the Formulary under the relevant review mechanism. Also, the Government has been providing additional resources to HA to meet the growth of drug expenses. In 2009-10 and 2010-11, we have earmarked an additional funding of $230 million in total to HA to incorporate six drugs for treatment of rare genetic diseases and two drugs for treatment of cancer (including Irinotecan for treating colorectal cancer and Vinorelbine for treating lung cancer) into the special drug category of the Formulary, and to expand the clinical application of 12 drug classes.  HA's expenditure on drugs also increased from $2.15 billion in 2006-07 to $2.68 billion in 2009-10.

     At the same time, HA has in recent years included in the scope of the Samaritan Fund various self-financed drugs that are proven to be of significant benefits, so as to subsidise the drug expenses of patients with clinical conditions requiring the use of these drugs but have financial difficulties. At present, a total of 14 self-financed drugs are included in the scope of the Samaritan Fund, among which 10 are for treatment of cancer, including Trastuzumab for breast cancer treatment, Interferon, Dasatinib and Nilotinib for leukaemia treatment, Imatinib for leukaemia and gastrointestinal stromal tumour treatment, Rituximab for lymphoma treatment, Oxaliplatin for colorectal cancer treatment, Cetuximab for initial treatment of locally advanced squamous cell carcinoma of the head and neck, Bortezomib for myeloma treatment and Pemetrexed for treatment of malignant pleural mesothelioma. In 2009-10, there were a total of 1,095 cases of assistance provided under the Samaritan Fund for the purchase of self-financed drugs. The amount of subsidy involved was $84.2 million and the amount paid by patients was $7.8 million.  

     HA regularly reviews the scope of the Samaritan Fund. Using drugs for treating cancer as an example, out of the above 10 drugs for treatment of cancer supported by the Samaritan Fund, four drugs were newly introduced this year; the coverage of application of another drug was also extended this year so as to benefit more patients. In addition, a self-financed drug covered by safety net and another self-financed drug have been repositioned as special drugs in the Formulary this year, and are now provided to patients with specific clinical indications at standard fees and charges.

     At present, there are 14 self-financed drugs for treating cancer, all indications of which are not covered by the Samaritan Fund. These drugs only have preliminary clinical evidence and marginal benefits, and can only prolong the life of patients for a short time. Patients can be prescribed with such drugs but they would have to purchase the drugs at their own expenses. In 2009-10, a total of 4,984 patients purchased these self-financed drugs at their own expenses and the total drug expenditure involved was $170 million. At this stage, more scientific evidence is required to confirm the clinical efficacy and cost-effectiveness of most drugs for cancer treatment and the actual benefits to patients. HA will continue to monitor closely the developments of these drugs and other cancer treatments, and consider introducing the use of relevant treatments in HA in light of the above considerations.

(b) The Healthcare Reform currently proposed aims to strengthen healthcare services and protection for the entire population and enhance the long-term sustainability of our healthcare system through reforms to public and private healthcare, primary care and specialised healthcare services of the overall healthcare system.  As regards the Healthcare Reform Second Stage Consultation, there are both public and private healthcare perspectives.

     The public healthcare system, which is heavily-subsidised, will continually provide target services for the public (including acute and emergency care; provision of healthcare and medical care for low income and under-privileged groups; treatment of illnesses that entail high cost, advanced technology and multi-disciplinary professional team work; and training of healthcare professionals) and serve as a healthcare safety net for the community as a whole. Under the existing safety net mechanism, patients with financial difficulties will be provided with the necessary drugs in accordance with their clinical needs at subsidised rates. The Government will only increase, and not reduce, its commitment to public healthcare. It will uphold its long-established healthcare policy that no one should be denied of adequate healthcare through lack of means.

     We put forward the Health Protection Scheme (HPS) with the aim to standardise and regulate private health insurance and healthcare services for those who use private healthcare services and subscribe to private health insurance under the Scheme. The Scheme is proposed in response to the outcome of the First Stage Consultation, where the majority view was in favour of wider choices, better protection and value-for-money private healthcare services, while maintaining the public healthcare system as a safety net for all. In drawing up the HPS, one of our considerations is that nearly one-third of the population have already subscribed to private health insurance of different types. The long-term burden on the public healthcare system will be eased and those in need of public healthcare services, including patients who need expensive treatments and drugs in the public system, will be benefited, if we can, through regulation of private healthcare services and insurance markets, ensure their sustained access to private healthcare services.

     The provision of financial incentives to members of the public who choose to use private healthcare services on a voluntary basis is not contrary to the subsidisation of the public healthcare system for the whole community. This is because it could effectively promote public health, enhance healthcare protection and relieve the pressure on the public system. It is also in line with the direction of promoting public-private healthcare partnership set out in the healthcare reform. The implementation of various pilot schemes of public-private healthcare partnership through subsidising the public for private services, including the Elderly Health Care Voucher Pilot Scheme, the Childhood Influenza Vaccination Subsidy Scheme, the Elderly Vaccination Subsidy Scheme, the Public-private Chronic Disease Management Shared Care Programme and the Cataract Surgeries Subsidy Programme, etc., is based on the same rationale and principle.

(c) As I mentioned above, the current Formulary has included many effective drugs for treatment of various diseases. These drugs, including a number of expensive drugs for treating cancer and various acute and chronic diseases, are provided to patients at standard fees and charges.

     Rapid advances in medical technology have brought in many new drugs into the pharmaceutical market every year. These available drugs are huge in number and vary widely in terms of cost, evidential support for their clinical efficacy, therapeutic effectiveness and side effects. As a publicly funded medical healthcare organisation, HA has to ensure rational use of public resources that serves the wide interest of the public. HA will continue to review the Formulary having regard to the principles of effective use of limited public resources and maximising health benefits to more patients.

Ends/Wednesday, October 20, 2010
Issued at HKT 18:46


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