1. Collaboration for a Provincial Hospital Formulary: The New Brunswick Experience Faith Louis Regional Manager QI & Support, Pharmacy Services Horizon Health Network April 13, 2015

2. Speaker Disclosure Presenter has no real or potential conflicts to disclose

3. Background – New Brunswick Population: 754,524 Only official bilingual province 2 Regional Health Authorities (RHAs) – Vitalité & Horizon 22 hospitals (small rural to large tertiary care site) 2013/2014 RHA Drug Expenditure: $70,848,457 (previous year - $71,138,716) Regionalization in Sept 2008 (8 to 2 RHAs) Provincial Health Plan 2009 –Included single provincial hospital formulary Provincial Drugs & Therapeutics committee (D&T) launched in Fall 2010 –Single committee structure with representation and support from both RHAs; universal decision binding to all hospital sites; single provincial hospital formulary

4. Areas of Collaboration with Provincial Pharmaceutical Services New Brunswick Department of Health, Pharmaceutical Services underwrites and administratively supports Provincial D&T –Meeting costs, per diems for physicians, admin support, translation, SharePoint collaborative site Personnel supporting NB Prescription Drug Plan (NBPDP) sit at main D&T committees/working groups and share information with RHA team –Status of medications under evaluation by D&T with NBPDP including restrictions, existence of price listing agreements (PLAs), upcoming reviews or changes at NBPDP Regular bi-weekly teleconferences between Executive Director, Department of Health, Pharmaceutical Services Branch, RHA Directors of Pharmacy, and Secretary of D&T (forms D&T secretariat)

5. Speaker Perspective Regional Manager of Quality Improvement and Support Services, Pharmacy, Horizon Health Network Pharmacist Manager in Regional Health Authority (RHA) Hospital perspective Principal Secretariat for NB Provincial Drugs and Therapeutics committee (D&T) Act as secretary for Provincial D&T working with RHA Directors of Pharmacy and Executive Director, Department of Health, Pharmaceutical Services Branch Provincial mandate & scope (Provincial Hospital Formulary)

6. Decision Making Process Representation at all levels by both RHAs (committee/subcommittee/working groups) –Provincial stakeholder feedback process –Subcommittees vet evaluations and submitted information: make recommendations to D&T –Decisions at D&T by majority vote (use electronic voting) Considerations –evidence informed approach Includes consideration of CADTH evaluations and reports, The Institut national d’excellence en santé et en services sociaux (INESSS) recommendations, NBPDP status –Seamless Care between hospitals and between hospital and community after discharge

7. Opportunities and Challenges Opportunities –Greater alignment between hospitals and publicly funded provincial outpatient drug program –Seamless Care between hospitals as well as between hospital & community post discharge –Better use of resources (financial, HR); potential for cost savings with better overall formulary management Challenges –What works in community doesn’t always work in hospitals and vice versa –Delays in decisions to allow alignment of formulary listings E.g. dabigatran, ticagrelor, chemotherapy agents

8. Rewards Major provincial initiative –great buy-in –closer working relationship and alignment with publicly funded provincial drug program –greater alignment of formulary listings between hospital and community and continuity of care post discharge Higher level of practice –evidence informed approach –degree of scrutiny is higher/expectations are higher –consolidation of human resources

9. Thank You Faith.Louis@HorizonNB.ca