The BC Provincial Renal Agency’s Glomerulonephritis Formulary

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Glomerulonephritis is a group of kidney diseases characterized by injury or inflammation of the glomeruli (the tiny units within the kidney where blood is cleaned). The autoimmune disease disproportionately affects younger Canadians but is rare – on average, only 267 cases are diagnosed per year in British Columbia. Patients face catastrophic kidney failure if they are not treated with expensive immunosuppressant medications.

Although patient numbers are small, glomerulonephritis is very costly to treat. In 2013 the BC Provincial Renal Agency (BCPRA) estimated the annual expenditure on immunosuppressant medications to be $2.2 million, or an average of $8,270.77 per patient. While expensive, these medications save patients from hardships associated with end-stage kidney failure and dialysis, while saving the BC health system the ongoing annual costs of life-support dialysis. But 86% of nephrologists in BC rated public and private insurance access to the medications as poor.

To address this significant patient need, the agency worked with BC Pharmacare and BC Transplant to develop a solution to provide equitable, evidence-based access to these life- or organ-saving medications. No previous analysis of its kind could be found in any jurisdiction.

Next, the BCPRA worked with Health Shared Services BC to secure immunosuppressant medications at significantly reduced prices, with average savings totalling 64%. The agency then tapped one of its existing province-wide distribution channels, a community pharmacy partner, to safely and securely deliver its medications directly to a patient when prescribed by a nephrologist.

The result is a first-of-its-kind glomerulonephritis formulary that was launched on April 15, 2014. It simultaneously improves access to essential medications and care quality while reducing annual medication expenditures by 64%, providing cost savings and not requiring patients to pay user fees. To top it off, the formulary is funded with cost-savings generated through another impressive initiative that won a 2012 Golden Apple Award from the Health Employers Association of BC.

The formulary ensures the right treatment is available to the right patient at the right time. It ensures that all patients in BC with glomerulonephritis have access to all medically-required immunosuppressant therapies regardless of their ability to pay. It reduces significant variability in prescribing patterns (estimated to differ from evidence-based guidelines by up to 46%) by providing reimbursement for evidenced-based use of medications and providing pre-printed orders with embedded evidenced-based treatment protocols.

In the first month after the formulary’s launch, the time required for approval of Rituximab, an expensive injectable treatment of last resort, was reduced from several weeks to less than 72 hours and the time required for approval of oral medications was completely eliminated. Cost-savings was estimated at $43,921.97; total cost-savings at the end of the year is projected to be around $1.4 million. Most importantly, feedback from both nephrologists and patients has been overwhelmingly positive.

The team plans on using its $2,500 sponsorship to continue to develop and share treatment algorithms and protocols based on latest research.