New concepts learnt:
Open (provide anything that anyone wants) vs. closed (selective list) formulary.
Formulary unrestricted, Non-formulary, Excluded category and formulary restricted
Hospital authorities need to keep factors like storage, cost, waste reduction in mind. Pharmacare (name changed to Pharmaceutical Services Division) doesn’t need to worry about inventory control. Their focus is simply funding and to provide drugs that are safe, effective and are most cost effective.
Hospital Act: Hospitals should provide whatever is clinical necessary for the patient. But if we are obliged to provide everything, then we need open formulary but there are issues with having a open formulary. Striking a balance is difficult. As the average length of stay in hospital is only 5 days, providing medications to patients as compared to using their own like advair and tiotropium results in cost incurrence. Other issues related to sending medications home include no records on pharmanet, cost issues for the patient after discharge, absence of labeling on the canister.
BC Health Authority Pharmacy & Therapeutics Committee and the associated medication formulary alignment initiative: It is hard to include everyone in order to make a decision. We discussed issues surrounding consolidation of the health authorities in lower mainland. P & T committee is responsible for making additions and deletions to the formulary. The rest of the session has been summarized by Herb Wong really well and I referred to the following link: http://herbwong.wordpress.com/. I went on the Ministry of Health Services website and found more information about Drug Review Process and Drug Benefit Council. It was interesting to know that some of our faculty members are part of DBC and Drug Review Resource Committee. As suggested by Dr. Tejani I also looked at the drugs that are going to be reviewed: hydromorphone, febuxostat, paliperidone palmitate and lacosamide. I was unaware of the fact that elgibile BC residents can provide input for consideration by the Drug Benefit Council using online questionnaire or a printed questionnaire. I also explored some links to CDR review of the drugs posted on the website. Overall, this session was very informative and I look forward to my PEO rotation with Dr. Tejani.
Later on the afternoon, we had a session with Pharmacy Technician Supervisor, Harinder Takhar and she helped us understand the role of the Technician Supervisors and potential innovative technician roles in pharmacy department. I was unaware of some roles played by pharmacy technicians for example, clinical pharmacy support technician, Drug use evaluation technician and STAT delivery service Technician.