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Pharmacy & Formulary

The Pharmacy & Formulary Review Committee determines which medications are essential in the care and treatment of patients with kidney disease.
Guidelines

Guidelines, protocols & resources

The BC Provincial Renal Agency provides funding for cinacalcet (Sensipar®) on a restricted basis to individuals who fail conventional therapy or who meet the criteria as described on the application form to be completed by the nephrologist.

There are currently no outcome studies with evidence that lowering PTH is of benefit with respect to morbidity and mortality. Due to some individual data that suggests that severe symptomatology may be benefited by lowering the PTH level (but not so low as to induce low bone turnover disease), the BCPRA Pharmacy Formulary Review Committee made the decision to fund on a restricted basis.

Nephrologists who would like to put a patient on cinacalcet (Sensipar®) are asked to submit the application form to BCPRA. An adjudication team of three Pharmacy Formulary Review Committee members will review each request, with approval given on a case-by-case basis. Due to costs, the use of this drug will be closely monitored. The funding policy will be re-evaluated periodically.

Key Cinacalcet Documents

 
Drug removal during hemodialysis affects drug effectiveness, the administration timing around the dialysis schedule, and the needs for supplemental dosing. This website contains dialyzability data from a literature review of pharmacokinetic studies in intermittent hemodialysis, pharmacokinetic parameters of the drugs, along with drug dosing recommendations in intermittent hemodialysis.

Poster presentation and chart

 
Starting on April 15, 2014, the BC Provincial Renal Agency will provide funding for select medications to individuals for the treatment of glomerulonephritis.

Oral Immunosuppressant Medications

Nephrologists who would like to put a patient on an immunosuppressant medication listed on the Glomerulonephritis Formulary are asked to register the patient in PROMIS and submit a completed application form along with a prescription to Macdonald's Prescriptions. The use of these drugs will be closely monitored and the funding policy will be re-evaluated periodically.

Oral immunosuppressant medications application form


Rituximab (Rituxan®)

Funding for rituximab (Rituxan®) will be provided on a restricted basis to individuals with glomerulonephritis who fail conventional therapy or who meet exceptional criteria as described by their nephrologist. In almost all circumstances, rituximab should be considered as a treatment of last resort.

Nephrologists who would like to put a patient on rituximab (Rituxan®) are asked to ensure the patient is registered in PROMIS and submit the application form to the BC Renal Agency. An adjudication team consisting of two members of the Pharmacy & Formulary Review Committee will review each request, with approval given on a case-by-case basis. Due to costs, the use of this drug will be closely monitored. The funding policy will be re-evaluated periodically.

Rituximab application form

 

One of the key goals of BCPRA’s Pharmacy & Formulary Review Committee is to facilitate medication best practices. The implementation of best practices processes in the management of expensive medications could save an estimated five to ten percent of the multimillion dollar renal drug budget.

As well, by using medication in a fiscally responsible manner, we are able to expand the list of formulary offerings at little additional cost.

The Pharmacy & Formulary Review Committee has prepared a summary of monthly costs for drugs featured on the renal formulary.

Medication choices will always remain at the discretion of individual physicians, in consultation with their patients. Implementation of BCPRA recommendations will be managed on a unit-by-unit basis.

For more information, contact the BCPRA at 604-875-7340 or by email.

 

This multidisciplinary tool covers Mineral Bone Disease Management in Stage 5 CKD/dialysis patients and was approved by the Medical Advisory Committee in August 2010.


Mineral bone disease management in stage 5 CKD/dialysis multidisciplinary discussion tool

 
Malnutrition is common among patients in stages 3 to 5 of chronic kidney disease (CKD). Maintaining or improving nutritional status is a challenge, and it is often necessary to rely on nutritional supplements to optimize intake.

The BC Renal Agency (BCPRA) funds nutritional supplements for all registered kidney patients, both those on dialysis and those in earlier stages of the disease. To access the renal nutritional supplement program, kidney patients at nutritional risk must registered with BCPRA through the PROMIS database.

The nutritional policy document below is a guide for registered dietitians and pharmacy partners.

Nutritional Supplement Policy

 
The full position statement and summary below outline the recommend use of Replavite/Renavite in adult CKD patients (non-dialysis). These documents were developed by an ad-hoc committee of the BC Renal Dietitians Practice Group and were approved by the BCPRA Pharmacy and Formulary Review Committee.

Full position statement

Summary

 
The BC Renal Agency provides restricted funding for Sevelamer HCL (Renagel) and Lanthanum Carbonate (Fosrenol) for the prevention of secondary hyperparathyroidism and risk of parathyroidectomy.

Funding is restricted on the basis that outcomes research available at this time does not firmly establish the benefits of this medication for indications other than preventing secondary hyperparathyroidism and risk of parathyroidectomy.

We are aware of the risks of calcification, but cannot justify expanded use of this agent based on the evidence available and prohibitive cost. Should new research or cost utility studies be published defining a benefit in other patients, we would welcome another review. (Please note that patients do have the option to pay for the medication themselves if it is considered to be indicated in other clinical circumstances.)

A guiding principle used by BCPRA in funding medications is proven efficacy for specific indications, as demonstrated through long-term outcome measures research. This principle ensures we are directing limited financial resources to the medications that have the greatest benefit for renal patients across the province.

Sevelamer of Lanthanum Criteria and Application Forms

Please note that the forms require the signatures of both (a) the nephrologist or renal clinical pharmacist, and (b) the renal dietitian (confirming dietary compliance).

 
Med Reconciliation

The BC Renal Agency and the health authority renal programs were the first in Canada to initiate medication reconciliation (or "med rec") for kidney patients across the continuum of renal care – from clinic, to admission, to transfer, to discharge, and back to the clinic.

Kidney patients, with their needs for multiple medications and frequent prescription changes, are at a higher risk than most patients for medication errors. In addition to improving patient safety, med rec supports easier hospital admission and discharge, providing patients with up-to-date medication lists, and better drug-use evaluation at patient, prescriber and agency levels.

In addition to being recognized by Accreditation Canada as a “leading practice,” the BC renal med rec program has received the following awards:

An Excellence in BC Healthcare Award of Merit (Collaborative Solutions category) from the Health Employers’ Association of BC in 2010

An Excellence in Quality: Across the Province award from the BC Patient Safety and Quality Council in 2011

A “Trailblazer Award” from Canada Health Infoway for the use of PROMIS in medication reconciliation. The award was part of Infoway’s ImagineNation Outcomes Challenge.

Reports & tools

BCPRA has developed a number of reports and tools to assist programs with medication reconciliation:

 

 

For more information about the BC renal med rec program, contact Dan Martinusen or Dr. Monica Beaulieu.



Pharmacies

 

The BC Renal Agency partners with a number of community pharmacies to provide a funded formulary of medications for patients registered with BCPRA.

In most cases, one partner community pharmacy is located near each hemodialysis unit in the province. Advantages of this partnership include:

  • a clear understanding of the expectations of both patients and BCPRA
  • a consistent approach to patient care
  • an opportunity for pharmacists to get involved in the specialty care required by nephrology patients

Note: One pharmacy, Macdonald’s Prescriptions in Vancouver, provides an enhanced level of service to BC kidney patients. Two of the most costly therapies – erythropoeitic replacement hormones (Erythropoeitin and Darbepoietin) and intravenous iron preparations – are distributed throughout the province by Macdonald’s. BCPRA chose to partner with one pharmacy for these products due to storage and shipping requirements, as they comprise a significant portion of our budget.

For community pharmacies

For information on how a patient can register for BCPRA funded medications, contact the BCPRA at 604-875-7340 or by email.

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