Drug Review and Selection Mechanism

Hospital Authority (HA) has implemented its Drug Formulary since July 2005 with a view to ensuring equitable access by patients to cost effective drugs of proven safety and efficacy through standardization of policies on drugs and drug utilization in all public hospitals and clinics. The Drug Formulary is supported by on-going evaluation of available new drugs and regular review of the prevailing list of drugs by relevant experts. At present, there are four categories of drugs in the HA Drug Formulary:

• General Drugs – These are drugs with well-established indications and cost-effectiveness which are available for general use as indicated by patients with relevant clinical indications and provided at standard fees and charges in public hospitals and clinics.
• Special Drugs – These are drugs used under specific clinical conditions with specific specialist authorisation. Special drugs are provided at standard fees and charges in public hospitals and clinics when prescribed under specific clinical conditions. Patients who do not meet the specified clinical conditions but choose to use Special drugs are required to pay for the drugs.
• Self-financed Items (SFIs) with Safety Net – These are drugs which are proven to be of significant clinical benefits but are very expensive for HA to provide as part of its standard services. These drugs are not covered by the standard fees and charges in public hospitals and clinics. Patients who require these drugs and can afford the costs have to purchase the drugs at their own expense. A safety net is provided through relevant funds, including the Samaritan Fund (SF) and the Community Care Fund (CCF) Medical Assistance Programmes, to subsidize the drug expenses of patients who have financial difficulties.
• SFIs without Safety Net – These include drugs with preliminary medical evidence only, drugs with marginal benefits over available alternatives but at significant higher costs, and lifestyle drugs (e.g. anti-obesity drugs). These drugs are not provided as part of HA’s standard services nor covered by the standard fees and charges in public hospitals and clinics. Patients who choose to use these drugs must purchase them at their own expense.

To keep clinical practice and drug use in sync with medical technology advancements and the latest scientific evidence, HA has mechanisms in place to conduct ad hoc and regular reviews of the HA Drug Formulary. The review process follows an evidence-based approach, having regard to the safety, efficacy and cost-effectiveness of drugs while taking into account the latest international practice as well as views of professionals and patient groups.

Requests for expanding HA’s safety net to cover additional SFI drugs, relaxing the prescribing indications for Safety Net drugs (SN indications) and repositioning drugs covered by the CCF Medical Assistance Programme under the coverage of the SF in the HA Drug Formulary undergo a similar prioritisation process which takes place twice a year. The concerned Coordinating Committees (COCs) and Central Committee (CCs) on disease groups should keep in view the prevailing list of SFI drugs and SN indications and submit proposals in response to call from Drug Management Committee (DMC) for inclusion of SFI drugs in the safety net or relaxation of SN indications. DMC usually calls for proposal submissions in the second and fourth quarters of each calendar year.

Following COCs / CCs’ submissions, DMC would convene a special meeting to prioritise all drug-related safety net proposals. The concerned COCs and CCs would be invited to present the clinical evidence and budget impact of their submitted proposals. DMC would then recommend a list of SFI drugs and SN indications, in order of priority, that are proposed for safety net coverage and relaxation in the new financial year. The recommended list would be sent to the Samaritan Fund Office (SFO) for processing and onward prioritisation by the Samaritan Fund Management Committee (SFMC). SFO would then submit SFMC’s recommendation with the prioritised list of SFI drugs and SN indications to the Medical Services Development Committee under the HA Board for consideration and final endorsement before implementation.

Proposals for repositioning SFI drugs under the coverage of CCF Medical Assistance Programmes and relaxation of prescribing indications of existing CCF drugs would undergo the same review and prioritisation processes, except that proposals prioritised by DMC would be sent for support by the HA Community Care Fund Administration Committee. The supported list of SFI drugs and CCF indications would be sent to the Community Care Fund Task Force Chairperson for final approval.

For more information of HA Drug Formulary, please refer to the website of HA Drug Formulary.