E-drug: New Drug Classes on Formularies (cont)
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The provincial formulary in Ontario considers a drug whenever a
manufacturer applies to have it put on the formulary. From my days on
the committee that considered the application and made the
recommendations to the government I can tell you that there were a
number of factors that influenced our decision. Since the Ontario
provincial drug plan covered drugs for people on social assistance and
those 65 and over, one of the main things we considered was whether the
drug was going to be used in these populations. We also looked at how well
it compared to drugs already on the formulary for the same
indication�i.e., safety and effectiveness. There was also a question of
whether the committee thought that the drug was likely to be
inappropriately prescribed. Finally, we considered cost. If a product
was no better than something already on the formulary but was more
costly then we would probably reject it. If it was better than the
other drugs available and less costly that was a no brainer and we would
recommend putting it on the formulary. The difficult question was when the
drug might be marginally better but was more expensive. Under these
circumstances, especially if we thought the likelihood of misprescribing
was high, we would recommend that it be placed in a category called
�limited use� which basically meant that the doctor had to fill out a form
justifying the use of the drug before it would be reimbursed by the
province.
Joel Lexchin
Joel Lexchin MD
121 Walmer Rd.
Toronto, Ontario
CANADA M5R 2X8
Phone: +416-964-7186
Fax: +416-923-9515
e mail: joel.lexchin@utoronto.ca
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