There is concern being raised about recent changes that have been made to the Barbados National Drug Formulary.
The changes which came into effect on April 1, 2018 have seen most of the branded drugs removed from the Formulary, a move President of the Barbados Association of Medical Practitioners (BAMP), Dr. P. Abdon DaSilva, says will have implications for patients across the country. Speaking to The Barbados Advocate, Dr. DaSilva explained that out of a meeting held last year with stakeholders regarding efforts to rationalise the Formulary, it was decided that some drugs would be eliminated from the Formulary entirely – all combination drugs and all brand-name drugs once a generic alternative was available. Those decisions, the medical practitioner said, while aimed at reducing costs, did not take all possible scenarios into consideration and the negative impacts they could have on the public financially and healthwise.
“As President of BAMP I met with the Director of the Drug Service earlier this year and expressed my concerns that first removing combination drugs from the Formulary did not make a lot of sense, because if you have a patient taking one tablet instead of two, or one tablet as opposed to three, you were trying to increase patient adherence, or maintain patient adherence as much as possible. But the implication for that is not only a question of adherence, but it now affects people outside of the polyclinic and hospital system who utilise the private pharmacies where instead of paying perhaps one dispensation fee, they are now faced with paying two or three dispensation fees and that is certainly going to affect the pocket of the private patient at the pharmacy level,” he lamented.
His concerns do not end there. DaSilva revealed that he also questioned whether in the switch to generics, if the Barbados Drug Service or the drug procurement companies would be able to secure a constant supply of generic drugs. The BAMP head is charging that because of poor planning and poor implementation of the new Formulary, there are currently a number of generic drugs which are not available, primarily those prescribed for the treatment of diabetes and hypertension.
“Not only are they not available at this point in time, there is discrimination. The intention was that if you had a prescription prior to April 1 that had repeats, you’d be allowed to continue with those drugs; as opposed to if you are getting a prescription as of April 1; in that case you would only be entitled to the generic drug. That’s discriminatory to start with. But as it has turned out, patients who have been given prescriptions for generics in keeping with the Formulary, and who are not able to get the generic drugs through no fault of their own, are being asked to pay full price for the brand-name, whereas the others who have had a prescription prior to April are only paying the dispensing fee,” he explained.
DaSilva disclosed that he contacted the BDS on Friday morning regarding that conundrum and he was assured that they would be advising the pharmacists that the previous status quo would remain in place for another month. However, he was adamant that up to yesterday evening, one of patients was presented with the same challenge when they visited the pharmacy. The BAMP spokesman said it is unclear to him whether the BDS followed through with that plan, or if all the pharmacists had not been made aware, and up to the time of the interview, DaSilva had yet to hear from the Director of the Drug Service, the Chief Medical Officer or the Minister of Health on the matter in spite of his efforts to alert them on the issue.
“My position is, if there is a temporary policy in place, all those patients who had to pay for their medication should be called and refunded, whether that is going to happen or not I do not know. But I think it is only fair that the Drug Service make it mandatory that all those patients be refunded. But where do we go from here? If at the end of April all the drugs are still not on island, what will be done?” he queried.
The medical practitioner said if the seeming generic shortage continues, the reality is that many persons cannot afford to pay full price for the branded drugs, and while some may choose to do so as it will benefit their health, given the limited disposable income due to the state of the economy, he suggested some may do so at the expense of another financial commitment.
The medical professional said he is aware that given the choice between purchasing a drug as opposed to some other essential item, patients will more often than not choose the non-drug item. In that vein, he warned that those who do not purchase the branded drug, depending on the condition of their diabetes or hypertension, could very well wind up in the polyclinic or hospital systems, adding to already high operating costs at those facilities.
“The potential of that happening is great, so what we have here is poor planning and poor execution that affects mostly the poor people. The Drug Service has been in existence for too long for us to be plagued with these problems,” he added. (JRT)