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Queensland Activity 2 perspectives: - Department of Health - QHMAC

Queensland Activity 2 perspectives: - Department of Health - QHMAC. Ms Ruth Hay Executive Secretary QHMAC & Director, Medication Services Qld Dr Charles Denaro Chair QHMAC & Director, Internal Medicine & Aged Care, RBWH CATAG March 2013. Department of Health:.

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Queensland Activity 2 perspectives: - Department of Health - QHMAC

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  1. Queensland Activity 2 perspectives:- Department of Health- QHMAC Ms Ruth Hay Executive Secretary QHMAC & Director, Medication Services Qld Dr Charles Denaro Chair QHMAC & Director, Internal Medicine & Aged Care, RBWH CATAG March 2013

  2. Department of Health: Medication Services Queensland • “Responsibility to support and/or represent the System Manager and Hospital and Health Services in pharmacy and medication management activities.” This includes statewide policy, which includes support for the statewide Medicines Advisory Committee – Queensland Health Medicines Advisory Committee (QHMAC) – and our statewide formulary, the List of Approved Medicines (LAM).

  3. Department of Health: Central Pharmacy has responsibility for the management of Queensland’s centralised purchasing and distribution for all pharmaceuticals and dental products to public health facilities. Also has a Manufacturing Unit for the preparation of “niche” products and individual patient extemporaneous compounding.

  4. QHMAC • Sets the formulary & guidance for the whole state. • Reduces duplication of effort and compensates the lack of expertise in regional centres. • Minimises aberrant local listings – (the power of the one or the few) • Intrinsically a narrow formulary (but bigger than PBS) • IPU system • Safety aspects • Equity of access across the whole state

  5. Advantages • Commercial Advantage • One robust contract system / Central Pharmacy • Economy of Scale - Large purchases • Training next generation of prescribers • Do not have to list everything – unlike PBS which follows the 4th arm of the National Medication Policy • Rejection = new price • Decision support – LAM and non-LAM, IPU • Same guidelines across the state • Target the right subgroups • Central monitoring system - Review & Audit • Find problems and issues early – See the big picture! • State-wide policy input; Education

  6. QHMAC’s achievements & work ongoing • 2012 • meets monthly (see notes) • 18 - 20 members, 70% average attendance • 100 agenda items + 12 items relating to therapeutic • 89 new LAM listings • 42 changes to LAM restrictions

  7. Risks to QHMAC’s role and function: 1. Central Pharmacy outsourcing (privatisation) • Currently Central Pharmacy assists with following: • Role in determining product specifications and negotiation of price offers • Assessment of tender offers and referral to QHMAC of those that require consideration of significant change management activities and/or clinical impact – CP provides prelim recommendations • Often negotiate prices off tender • Manufacturing Unit • Excellent relationships with manufacturers – very important with supply issues, emergency situations, pandemics • Provides data from their state-wide pharmacy system for ordering. This is a useful data source for the provision of utilisation data to QHMAC • All under threat

  8. Risks to QHMAC’s role and function: 2. Quality of advice to QHMAC • QMAIS (Qld Medicines Information Service) • literature reviews to QHMAC • future in doubt. May move to a “user pays” model • Conflicts of interest • Current CoI policy under review at the request of the Committee sponsor. If members are not able to contribute to certain discussions of the Committee their knowledge and expertise cannot be shared and considered as part of the decision making process • Committee sponsor is non clinical • QHMAC Secretariat – loss of 1FTE

  9. Risks to QHMAC’s role and function:3. System changes • Hospital & Health Service Districts (HHSs/LHNs) currently must purchase from Central Pharmacy and comply with the LAM (Health Service Directive) but this is only in place until June 2014 • Leakage and the impact on tendering processes • Antimicrobial surveillance • no capacity to enforce • CHRISP antibiogram work – future in doubt • Hospital resource issue

  10. Risks to QHMAC’s role and function:3. System changes • Ceased - work with local MACs through Queensland Health Medicines Collaborative: • focussed on IPA’s, medication safety, use of limited evidence medicines, DUE’s (not audits) • Ceased - work to develop state-wide high cost drugs committee (ie IPU use and equity) • Very limited - statewide education on ‘new’ medicines

  11. QHMAC:Current drug issues of concern • Pregabalin / gabapentin • Sugammadex - removed • Biosimilars • Dalteparin/enoxaparin – (safety and education)

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