HEALTH CARE BENEFITS IN CANADA March 2006 We Take a Closer Look Wendy Murkar Vice-President, Claims Administration Green Shield Canada State of health care in Canada Issues affecting benefit utilization Impact on benefit plan design STATE OF HEALTH CARE IN CANADA Benchmarking of
Positivelife.org.auDispensing highly specialised drugs for the treatment of HIV By Levinia Crooks.
can initiate HIV therapy, so there the virus at the various stages of its is no need for their patients to ever life cycle. Standard care for HIV rom July 1, 2015 retail go to a public hospital for HIV involves using a combination of Fpharmacists will be able to management. It was logical that compounds, which have an impact be reimbursed for the supply of these drugs be the first moved to on these different stages. These are highly specialised and high-cost the harmonised arrangements.
entry inhibitors, nucleoside and drugs that are prescribed for the There are many other drugs on nucleotide inhibitors, integrase management of HIV. the s100 Highly Specialised Drugs inhibitors and protease inhibitors These antiretroviral drugs Program and we anticipate that (see figure).
are listed under section 100 of Associate Professor Levinia Crooks AM, if the rollout of HIV medicines While combination therapy the National Health Act 1953, CEO, Australasian Society for HIV and Clozapine is successful, then is very effective at driving viral which has until now restricted Medicine (ASHM).
there will be more s100 medicines replication below the limits of their supply to public hospital moved to this streamlined detection, it does not eradicate pharmacies and their agencies pharmacists. These found that the dispensing program. At ASHM the virus. If therapy is stopped, or in community pharmacy drugs could be safely dispensed we are hoping that hepatitis B HIV resumes replication and can if they are prescribed through in the community and that the medicines will be able to move rebound very quickly to levels that private hospitals, using a complex process was acceptable to both over to retail pharmacy soon and will cause immune system damage.
pharmacists and their patients.
have made representation to the Poor adherence to treatment Dispensing of maintenance The HIV pilot was conducted in PBAC on this. Hepatitis B is regimens can also render individual prescriptions for Clozapine, a NSW. The Pharmaceutical Benefits treated by a subset of drugs also drugs, drug classes or multiple common antipsychotic drug, will Advisory Committee (PBAC) used to treat HIV.
classes ineffective. This happens also be able to be dispensed in has been considering the issue of The recent recommendation as a result of the development of community pharmacy using these supply of highly specialised drugs of the PBAC to put the new resistance, which can be caused by for many years and one of the hepatitis C drugs onto section repeated treatment interruptions, issues complicating any change to 85 means that these medicines missed doses and taking medicines Why is this happening?
arrangements has been the PBS will also become available in at incorrect intervals as the Both HIV medicines and reimbursement system. More retail pharmacy. There are many trough levels drop below the Clozapine are lifelong treatments. recent changes to pharmacy online potential changes being considered concentration required to sustain While current HIV medicines are claiming arrangements has helped in the pharmacy and medical viral suppression.
much more effective than earlier bring about changes.
benefits areas. There seems to be The Pharmaceutical Society of products, they do not cure HIV. a real move to harmonise and Australia, in collaboration with The drugs need to be taken daily recommendation to the federal simplify prescribing and dispensing ASHM, the Pharmacy Guild of and, as things stand, lifelong. Department of Health that there Australia and Society of Hospital If patients go off their HIV should be expanded access to HIV Some of this, particularly Pharmacies Australia, is producing medicines, even for a short while, drugs and Clozapine. Having claiming and monitoring, is a resource for pharmacists the virus rebounds. It is only the knowledge of the successful facilitated by the introduction of that explains HIV treatment consistent, daily treatment using pilots no doubt contributed online pharmacy ordering and in some detail. It explores the a combination of drugs that keeps to their decision. The previous reimbursing. Along with expanding different medicines, their use and HIV under control.
health minister accepted this access for patients, these initiatives pharmacokinetics. It provides recommendation and, in 2014, will move care of some chronic information about drug-drug Patient access?
announced that HIV antiretroviral conditions to the community and interactions, adverse events, side Patients and their carers have prescriptions written after July mean that retail pharmacy plays effects and toxicities, and also advocated for more normalised 1, 2015 would be able to be a far more strategic role in the provides a range of useful practice treatment access for many years. dispensed in retail pharmacy.
ongoing management of patients.
and counselling points.
Patients with HIV have been able to get their HIV management in Why is this restricted to HIV
HIV treatment mechanisms
Managing HIV antiretroviral
the community from authorised medicines and Clozapine?
therapy in the retail pharmacy
HIV s100 prescribers for many The s100 Highly Specialised HIV is a retrovirus transmitted by HIV medications will remain years, but they have had to return Drugs Program has largely been blood and some body fluids (semen on the s100 Highly Specialised to the hospital to collect their restricted to specialists in public and vaginal fluid). As a retrovirus, Drugs Program. This means they hospitals. Patients have had to HIV turns its RNA into DNA are outside the 5th Community While this works for some attend a hospital to see their during reverse transcription. The Pharmacy Agreement, so there people, it can be very inconvenient, specialist, but, in HIV, general viral DNA is then incorporated is no requirement to supply the especially if people live some practitioners who have additional into human cell DNA, where the medicines within 24 hours, but distance away from the hospital or training and are registered as cell replicates. New viral particles the bulk of the medication will are working, as hospital pharmacy HIV s100 prescribers have been are also liberated from infected be available through the major hours are much more restrictive managing HIV in the community CD4 cells. This means that the wholesalers so they will likely be than community pharmacy hours.
for more than 20 years.
virus is hard to kill through normal able to be dispensed fairly quickly, There have been pilots run in Current estimates suggest that immune responses or treatment probably within two days.
a number of locations to test in Australia at least 65 per cent of because it is incorporated into the The drugs are also high-cost the acceptability of community HIV treatment is prescribed by human CD4 cell.
and it is expected that HIV s100 dispensing for patients and retail general practitioners. These doctors Antiretroviral treatment attacks prescribing will be managed like the dispensing of other expensive drugs such as Humira or Enbrel for the management of rheumatoid arthritis. Many patients living with HIV have had to manage complex supply arrangements: accessing a hospital pharmacy with restricted hours, perhaps having to travel long Helps protect your lips against cold sores.
distances to get to a hospital and, in many smaller centres, having to get the hospital pharmacy to order in their medicines.
Patients and their clinicians and advocates have been asking for drugs to be supplied in retail pharmacies for a long time, so working out ordering and supply arrangements in such a way that facilitates supply is something that pharmacists should discuss with the patients who have HIV. Each arrangement might be different, but may be easily included in patient-reminder systems.
How can you plan
Image courtesy of Positively Aware: for this?
Pharmacies which are near hospitals with HIV services, within her family: ageing dispensing. It is probably sexual health clinics or parents, adult children, also a good opportunity community s100 prescribers grandchildren and, of to review privacy and are likely to have more course, herself and her confidentially arrangements occasion to dispense HIV husband. Mr Cormack in the pharmacy. People medicines. You can find described the important role who have good experiences a list of community s100 Maggie plays in influencing in pharmacy will keep prescribers on the ASHM the buying power of those coming back and word- website www.ashm.org.au/ of-mouth referrals and Virapro X contains lysine
hiv/pharmacy. However, People with HIV will recommendations will likely many people may choose be a bit like Maggie. and has been developed
to get their medicines from We know from surveys People living with HIV, to work in three ways.
a pharmacy near work or undertaken by HIV like other patients with home or another convenient consumer organisations chronic conditions, will MOISTURISER
location. Pharmacists may that while people living require lifelong care and, Helps keep lips hydrated.
have regular patients they with HIV want to access as such, represent a group know have HIV. In this case their medicines in the of patients recognised as they can initiate a discussion community, they also contributing most to a retail SPF 30 SUNSCREEN
with the patient about express concerns and fear pharmacy's bottom line.
Helps prevent UV damage.
whether he or she would that their confidentially and The HIV population like you to dispense their privacy may be at risk.
in Australia is ageing PROTECTION
and experiencing the Helps maintain lip health.
Chris Cormack, writing pharmacists have strong comorbidity associated in Retail Pharmacy March ethical standards, but with that process. They are 2015, introduced readers fears and concerns can be eager to have community EGO PHARMACEUTICALS PTY LTD to Maggie, a 60-ish female as restricting as actually pharmacy access and also 21–31 Malcolm Road, Braeside 3195 Australia australia +61 3 9586 8800 toll free 1800 033 706 patient who probably experiencing stigma. So want their privacy respected. ‘Ego' and ‘Virapro X' are trademarks of Ego Pharmaceuticals dictates much of the pharmacists will need to If treated well, they are Pty Ltd in Australia and other countries. 2015 Ego. medicine-taking behaviour take special care in dealing likely to become loyal Always read the label. Use only as directed. 0438O of four generations with requests for HIV patients and customers. If symptoms persist see a healthcare professional. EG
ASAMBLEA LEGISLATIVA - REPUBLICA DE EL SALVADOR DECRETO Nº 218.- LA ASAMBLEA LEGISLATIVA DE LA REPÚBLICA DE EL SALVADOR, en uso de sus facultades constitucionales, a iniciativa del Presidente de la República por medio del Ministro de Justicia y oída la opinión de la Honorable Corte Suprema de Justicia, DECRETA, la siguiente: LEY DE NOTARIADO