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Wednesday, November 23, 2016, 22:13

Rising number of unlisted drugs being prescribed

By Shadow Li

HONG KONG - The city’s public hospitals and clinics often failed to charge patients full rates when prescribing non-subsidized drugs - despite the drugs’ unproven safety and efficacy, an audit report released on Wednesday revealed.

Clinicians at hospitals and clinics under the Hospital Authority (HA) can prescribe new drugs not listed on the HA-approved Drug Formulary in emergencies or exceptional cases. But there was an increasing tendency to use such drugs, the majority of which are not registered in the city.

There was a 25 percent increase over the past two years in the use of drugs outside the government’s Drug Formulary - a list of drugs that are approved and subsidized by the government for their safety, efficacy and cost-effectiveness, the report showed.

For the 2015-16 financial year, the Hospital Authority spent HK$249 million, or 4.4 percent of the total drug expenditure, on 362 drug items which were not on the Drug Formulary - up from 290 unlisted drug items in the 2013-14 financial year.

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Of these, 73 percent are not registered in Hong Kong, with clinical benefits, efficacy, safety and cost-effectiveness unevaluated by the Drug Advisory Committee - the body responsible for formulating the drug list.

The other ones that are registered involved 73 drugs. These include 45 drugs for which no applications for listing on the Drug Formulary had been made, although some of these were found to be in regular demand at public hospitals and clinics.

While the tendency to prescribe unlisted drugs increases, the willingness to file for applications to add them to the approved drug listing remains low. In the two years from 2013-14 to 2015-16, only 51 drugs were added to the formulary.

Applications for new drug listings are initiated by HA clinicians. The report pointed out that only a few leading HA hospitals and clinics had regularly made such applications.

The report revealed that HA didn’t have guidelines for pricingthe drugs outside the formulary.

Only 3.5 percent of the 171,200 prescriptions of those non-subsidized drugs in the 2015-16 financial year were paid by patients in full cost and the remaining were covered by the government.

The report also warned the HA of drugs being wasted. Dosages administered at one go at specialist out-patients clinics rose by 7.8 days, from an amount satisfying the patient’s need for 76.4 days to 84.2 days. Drug prescriptions for a long duration will lead to unused drugs and waste.

Leung Pak-yin, HA's chief executive, said the authority welcomed audit suggestions about its drug management system.

The HA, in a written statement to press on Wednesday, said that among the key measures it will take to follow up the audit recommendations, it will formulate a comprehensive guideline on use of drugs outside the Drug Formulary. It will continue to include new drugs based on safety, efficacy and cost-effectiveness considerations.

The HA said it will launch a drug refill service to break down long-duration prescriptions.

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