To compare the public drug formulary processes of major healthcare systems.
Method
A systematic review was done in October 2015 on public-funded drug formulary management practices of various countries. Besides PubMed and Scopus, individual organizations’ websites were explored. The same keywords (‘drug formulary’, ‘medicine list’, ‘management’, ‘maintenance’) were used.
Results
The public formulary processes of four countries in different continents were selected. The formulary governing body, drug listing initiation, pharmacoeconomics technical assessment, funding selection criteria, and committee decision transparency were compared.
For US, which depends largely on varied insurance plans, the Medicare prescription drug coverage plans managed by Centers for Medicare and Medicaid Services, was selected for ease of comparison. The Pharmacy and Therapeutics Committee reviews and decides on new drug inclusions for various health system pharmacies. Selection criteria include appropriateness, safety, cost-effectiveness, and efficacy. The Medicare Parts C and D provide some degree of prescription drug coverage, but these are constrained by individual providers.
In United Kingdom, the National Institute for Health and Care Excellence (NICE) Technology Appraisal Committee (TAC) makes recommendations to the National Health Service (NHS) on selection of drug for funding. The NICE TAC evaluates drugs with help from Evidence Review Groups and Assessment Groups commissioned by NHS National Institute for Health Research. Non-health factors are also considered along with comparators available.
The Australian Pharmaceutical Benefits Advisory Committee (PBAC) recommends to the Minister for Health on Pharmaceutical Benefits Scheme. The PBAC assesses new drugs with help from Drug Utilization Subcommittee and Economics Subcommittee. The drugs must be approved by Therapeutic Goods Administration for quality, safety, and efficacy are already ensured.
In Singapore, the Drug Advisory Committee (DAC) recommends to the Ministry of Health on Standard Drug Lists and Medication Assistance Fund drugs, which are covered by means-tested subsidies. The Pharmacoeconomics and Drug Utilization Unit provides technical and secretarial support to the DAC. As with the other countries, the preference is for drugs which are proven efficacious and cost-effective.
Conclusion
Each country has a formulary management process unique to its social histories and policy-makers’ believes. There is no ‘one size fits all’ model. While comparing various formulary strategies gives an overview on the focus of each healthcare system; developing countries attempting healthcare reform need to consider their own developmental stages and public expectations of healthcare funding, without blindly adopting any model in formulary management.
