In Canada, the same drug may be evaluated by many different groups – myriad formulary committees – for hospitals, private drug plans, national government plans (Veterans Affairs, noninsured health benefits, Royal Canadian Mounted Police), etc, which results in much duplication and is expensive. A national system may result in less ownership by both health care providers and patients, and less determination to make the system work. The aspects of pharmaceutical costs that deal with utilization are often best dealt with at a local level . Flexibility and the ability to respond to local needs and concerns may be lost. The Canadian Coordinating Office for Health Technology Assessment aims to assist provinces with their decision-making about pharmaceuticals and may centralize some functions. It is an example of provincial collaboration at a national level. It provides clinical and economic comparative evaluations of pharmaceuticals, but it is too early to assess its impact. The Canadian Prescribing Practices Network Project is another intraprovincial and interuniversity approach, but issues of structure, coordination and funding are still being resolved. buy diabetes drugs
Economic guidelines for pharmaceuticals in general, and the Australian economic guidelines in particular, have been vigorously debated by academics, health professionals and pharmaceutical industry representatives . The Australian Pharmaceutical Manufacturers Association conducted a survey of the manufacturers’ opinions of the 1992 guidelines. The Australian system is undergoing review with input from the industry. It needs to be further evaluated to determine the quality and consistency of decision-making; the effect of the listing procedures and decisions on the availability, use and price of drugs; and patient outcomes and overall health care costs. The possible unintended consequences of listing procedures, including the rise of costs in other sectors, need to continue to be examined. The administrative costs need to be defined. The reader is directed elsewhere for detailed comments regarding economic guidelines and for a comparison of the Canadian and Australian guidelines .