Pharmacies across SingHealth institutions improve availability and harmonise prices of drugs

Many of our patients suffer from multiple conditions, especially the elderly. For example, 72 year old Mr Tan has diabetes, along with hypertension, kidney failure and eye issues. He needs to see several specialists at different institutions. He takes multiple medications to manage his coexisting health problems.

Imagine his surprise when he found that Empagliflozin, the drug he takes to treat diabetes, was in stock at the National Heart Centre Singapore (NHCS) but not at the Singapore General Hospital (SGH), although they're only a short walk from each other. To further his confusion, he discovered the drug was priced differently in the two institutions.

Associate Professor Lita Chew, Head of Pharmacy Department at the National Cancer Centre Singapore, said, "It doesn't make sense to the patient that there's a discrepancy in availability and pricing within the same cluster. It causes inconvenience to patients as they may need to make an extra trip just to get all the medications they need."

"This system cuts down drug duplication, increases availability for patients, and gives better visibility of standard/subsidised and non-standard drugs to both patients and healthcare staff."

- Prof Ho Lai Yun, Emeritus Consultant, Neonatal & Developmental Medicine, SGH

This was a situation that had to be fixed, but one that was going to be an uphill task. Trying to streamline policies and processes across institutions was going to be a challenge. Historically, each SingHealth institution has a Pharmaceutical and Therapeutics committee which has always been self-running; each institution has their own medication selection, governance and usage as they deal with different specialties.

Enter more than 20 dedicated doctors and pharmacists working together in the SingHealth Pharmacy and Therapeutics Council (SPTC), chaired by Assof Prof Lita Chew and Professor Ho Lai Yun, Emeritus Consultant of Neonatal & Developmental Medicine in SGH.

An integrated formulary

The first task for the SPTC was to identify every drug available in all the SingHealth institutions. They found there were some 2,200 different items, with about a third of them being standard drugs.

Prof Ho explained: "We have quite a big collection of drugs, but the hallmark of a good hospital is not the number of different drugs available, but their effective usage."

The Council then created an integrated cluster formulary. Under this common formulary, the Council classified the drugs into three groups to harmonise the prices and availability across each group. About 830 standard drugs commonly prescribed to patients across hospitals and centres are in the first category. These standard drugs are now available in all SingHealth institutions. The second group are non-standard drugs which are used in three institutions or more, while in the third are non-standard drugs unique to only one or two SingHealth institutions.

"This system cuts down drug duplication, increases availability for patients, and gives better visibility of standard/subsidised and non-standard drugs to both patients and healthcare staff," shared Prof Ho.

Teo Siew Chong, an NHCS pharmacist shared that it's been a positive experience.

He said, "Now we have common access to the cluster formulary, we know which drugs are used and where they are stored. We know what the other institutions keep and have a better understanding of the differentiation between institutions. All of this helps us better advise our patients."

"Patients can move between institutions with ease, knowing that they can get the same drugs at the same rate at different institutions."

More in the works

SPTC has also established domains experts to evaluate new drugs, update each domain's lists of medications, and ensure that they are priced consistently across the cluster.

"Pharmacists from different institutions come together to discuss, iron out problems, and form policies to govern how we operate," Siew Chong highlighted.

Moving forward, the SPTC is addressing problems due to use of multiple medicines or polypharmacy: adverse drug reactions, improper use of drugs, wastage, and under- or over-use of medicines. The Council is also looking into the use of inappropriate medication, regulating sponsorships by pharmaceuticals companies and standardising medication assistance schemes. These will help to cut medication costs for patients, ensure clear governance and ensure patients have access to the right medications they need.  

Prof Chew said, "We've got the Council's staff to thank for gathering everyone to find out what our patients need and how we can provide the best care for them together."