A Proposed Framework for Formulary Listing in Low-Income Countries
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CURRENT OPINION
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A Proposed Framework for Formulary Listing in Low-Income Countries Incorporating Key Features from Established Drug Benefit Plans Vakaramoko Diaby, Claudine Laurier and Jean Lachaine University of Montreal, Faculty of Pharmacy, Montreal, Quebec, Canada
Abstract
Formularies of reimbursed drugs are widely adopted tools in healthcare systems. However, little is known about the selection process of drugs that appear on these formularies. The aim of this paper was to shed light on this process by reviewing the way selected public Drug Benefit Plans in high-, middle- and low-income countries, including Canada, the US, UK, France, Germany, Brazil, South Korea and Ghana, manage the formulary listing process. Common steps and challenges are identified and this information used to make recommendations for developing a framework for formulary listing in low-income countries. We found that all DBPs studied used a formulary to list reimbursable drugs and the selection criteria utilized to determine which drugs should be listed were similar between plans, although weighting of individual criterion differs and the composition of the committee (i.e. physician vs economist) is likely to have an impact. The WHO model list of essential medicines plays a bigger role in formulary selection in middle-income countries than in high-income countries. In low-income countries, the focus is on the prioritization of health interventions and improving access to healthcare. On the basis of our review and an appraisal of the health needs of lowincome countries, we have proposed four steps that are the pillars of our framework for formulary conception in low-income countries. These steps are the identification and weighting of relevant formulary listing criteria (combining both literature review and qualitative research approaches), the determination of priority diagnostics/treatments to be assessed, the criteria scoring and the treatment ranking by priority order of reimbursement. Finally, for the purpose of developing a formulary, we recommend use of the multicriteria decision analysis approach to guide priority drug ranking.
1. Background Health system reforms, motivated by rapid diffusion of health technologies (pharmaceuticals and devices), globalization, changes in population demographics, emergence of new diseases and the development of mass media and their effects on patients’ expectations,[1-3] have contributed to the development of health technology assessment (HTA), with the aim of reinforcing the decision-making process surrounding drug reimbursement. HTA can be defined as ‘‘the systematic evaluation of properties, effects, and/or impacts of health technology. It may address the direct, intended consequences of technologies as well as their indirect, unintended consequences.’’[4] Because of its
ability to identify technologies that provide best value for money,[4] HTA has been extensively utilized for pharmaceutical coverage or formulary listing purposes in hig
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