With reference to the article published in The Malay Mail Online on 5th December 2016 titled “Why New Cancer Drugs Are Unavailable in Malaysian Public Hospitals”, the Ministry of Health (MOH) would like to clarify some misunderstandings highlighted in this article.
As in most other countries, the MOH has a standard formulary for medications, informally known as “the Blue Book”, consisting of list of medicines that serve as a guide for doctors with regard to medicines that can be prescribed for patients seeking treatment in MOH facilities. All medicines listed in the formulary are provided to patients without any charges – patients only pay a mere RM1 to RM5 when seeking outpatient treatment; and for inpatient services, they only pay for ward charges and certain investigations while medicines are provided for free. There is hardly any other country in the world where patients, including those requiring treatment for cancers, can get such access to such services.
Sunitinib, the drug which is being referred to in the MalayMail article, has already been listed in the MOH formulary. Prior to being listed in the formulary, the government had already spent approximately RM420,000 to treat 11 patients who required Sunitinib. In 2015, MOH spent RM240 million just on cancer therapy and this amounted to 10% of the total drug budget.
For a medicine to be listed in the Blue Book, it must first be registered in the country. The company responsible for marketing the product shall apply for it to be listed in the formulary. It will then be evaluated based on criteria such as proof of superior effectiveness compared to standard therapy, a positive cost benefit ratio and an acceptable safety profile. However, not all medicines get listed into the formulary if there is a very high budget impact, especially the newer targeted cancer therapies. Nevertheless, any patient requiring these therapies are never deprived of access to these medicines as MOH still approves the use of non-formulary medicines on case-to-case basis.
Furthermore, other targeted therapies for lung, liver and renal cancers, gastrointestinal stromal tumours, hematological conditions are among cancer treatment that are already listed in the formulary; although they are very costly. Mostly are available in tertiary MOH hospitals as these conditions require specialised care. As the new targeted therapies for cancer are very expensive, the MOH has already engaged with the pharmaceutical industry through Patient Access Schemes and Patient Assisted Programs. These are among measures taken in making these medicines more affordable for MOH thus enabling a greater number of patients to receive these treatments. Therefore, the MOH will continue to strive in providing the best possible care for our patients through the optimal use of medicines.
DATUK DR NOOR HISHAM ABDULLAH
DIRECTOR GENERAL OF HEALTH MALAYSIA
6th December 2016