...wants duplication of medicine dealt with

This Health Minister Terrence Deyalsingh says, is to provide patients in the public health sector with medicine 12 months a year.

Deyalsingh said the country’s formulary is currently at 1,000, which he hopes to be reduced to 700. After examination of how that affects things, there might be further reduction. He added that too often, medicines are added to this list for economic reasons. “There was a decision to rationalise the formulary since I became minister. So that is a work in progress.” “What has happened over the years is that you will have advocates of a particular drug and they would just keep adding drugs to the national formulary. In adding drugs it does not mean your budget to purchase drugs also increases.

“Over the years the different categories of states that you want to treat, Diabetes, Cancer, HIV/AIDS, if you started a formulary say five years go with five drugs to treat Diabetes every year, you have advocates to put a new drug onto the formulary so the five drugs to treat one condition grows from five to now ten.

“Multiply that by every category of disease.

HIV, oncology, eye, dental and what you have is a formulary that is expanding and expanding for economic reasons and then the national budget remains, basically, the same.” The National Insurance Property Development Company (NIPDEC) has an annual budget of $750 million for the procurement of the country’s formulary.

“The formulary has became bloated because you have ten different versions of the same drug,” he said.

The rationalisation process was starting for this year’s tender cycle, which starts in May and June.

He said the World Health Organisation (WHO) recommends a formulary of 350 drugs.

He added that India has a formulary of 300 drugs for a population of one billion, “and we have a population of 1.3 million and have 1,000 drugs.

Deyalsingh said the recommendation would be made that prescribing by brand has to end.

“We are looking at, at the end of the process, it may be a little more but we are looking to rationalise. We have already brought it down to 700. We are going to stop there for now because we cannot shock the system in one year.

Let us see what this does. We are working closely with all the specialists to get them on board to alter their prescribing habits.” He said the in private sector, doctors were free to prescribe by brand and to send their patients to buy by brand but if tax payers dollars were being spent it was a different scenario.

He said there were still shortages with drugs for cancer patients because of the same system he was speaking to. “The first set of protocols we have adjusted are oncology and HIV/Aids because that is the biggest chunk of the drug budget.” “A national formulary cannot be everything to everybody...If you have people being trained in different parts of the world, they are going to come to TT and practice in their private setting and recommend any drug that they are taught in their part of the world. But do you know what happens, they then go to the formulary committee and want to get their drug put on the formulary because they have been trained in a particular way. We cannot do that in TT for the public setting, it is what the Government formulary is and you prescribe that.” He said the ministry was setting the guideline for what gets onto the formulary based on what the patient deserves not for economic reasons.

He said the other areas being targeted are metabolic diseases such as diabetes and the high expenditure areas first.