Canadian Pharmacists Journal - May/June 2019 - CPH8

Proposed Model for Dispensing of Critical Dose Immunosuppressant Drugs

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Collect information

*	Patient	insurance	and	other	drug	coverage	information	
*	Available	drug	product	options	(i.e.,	innovator	vs.	alternate	formulations)
*	Is	this	a	continuation	of	therapy?	If	yes,	determine	which	drug	product	
patient	has	been	receiving.

Assess options

*	Mandatory	vs.	optional	interchangeability
*	Out-of-pocket	cost	to	patient	for	each	option
*	Patient	preferences,	if	applicable
*	Product	monograph	cautions	on	switching

Select and dispense
product

*	If	dispensing	consistent	formulation,	no	further	actions	required
*	If	dispensing	alternate	formulation,	proceed	to	Step	4	
*	Ideally,	substitution	of	an	alternate	formulation	should	occur	in	consultation	
with	prescriber

*	Notify:	Patient	and	prescriber	of	drug	product	switch
Actions if dispensing *	Monitor:	Recommend	monitoring	of	blood	concentration	post-switch
alternate formulation *	Educate:	Patient	on	drug	product	and	reinforce	directions	for	use
*	Document:	In	patient's	file

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Work	Group.	Am J Transplant.	2009;9(suppl	3):S1-S157;	5.	Knoll	GA,	et	al.	Am J Kidney Dis.	2010	Aug;56(2):219-46;	6. PrNeoral® and PrSandimmune®IV
Product	Monograph	revised	Jan	2015,	accessed	Sept	2018;	7. PrSandoz®	Tacrolimus	Product	Monograph	revised	Jan	2016,	accessed	Sept	2018;	8.
Pr
Prograf®	Product	Monograph	revised	Nov	2016,	accessed	Sept	2018;	9.	Advagraf®	Product	Monograph	revised	July	2015,	accessed	Sept	2018;	
10. PrRapamune®Product	Monograph	revised	Oct	2017,	accessed	Sept	2018;	11. Harrison JJ Transplantation.	2012;93:657-65;	12.	Shuker	N,	et	al.	
Transpl Int.	2016;29(11):1158-67;	13.	Pollock-BarZiv	SM,	et	al.	Pediatr Transplant.	2010;	14:968;	14.	Savoldi	S,	et	al.	Transplant Proc.	1997;29:288;	
15.	Borra	LCP,	et	al.	Nephrol Dial Transplant.	2010;25:2757;	16. Health	Canada.	Available	from	https://www.canada.ca/content/dam/hc-sc/
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Hajj,	et	al.	Expert Rev Clin Immunol.	2015;11(5):659-72;	19.	Saengram	W,	et	al.	Eur J Clin Pharmacol.	2018	Oct;74(10):1249-60;	20.	McCormack	PL,	
Drugs	2014;74:2053-64;	21.	Weiler	N,	et	al.	Transplant Proc.	2013;	45(6):2321-5;	22.	Glick	L,	et	al.	Transp Res.	2014;3:7;	23.	ISMP	Canada	Safety	
Bulletin	2009;9(5);	24.	http://www.competitionbureau.gc.ca/eic/site/cb-bc.nsf/eng/03798.html;	25.	https://	abpharmacy.ca/sites/default/files/
StandardsOfPractice_May2014_v2.pdf;	26.	https://	www.ab.bluecross.ca/dbl/pdfs/ahwdbl_sec1_critint.pdf;	27.	http://library.	bcpharmacists.org/6_
Resources/6-4_Drug_Distribution/5016-FYI-	Drug_Interchangeability_	Update.pdf;	28.	College	of	Pharmacists	of	Manitoba,	2013;	http://www.
cphm.ca/uploaded/web/Legislation/	Pharmacy-Practice-Guide/Guide-to-Pharmacy-Practice-Final.pdf;	29.	https://www.health.gov.nl.ca/health/
prescription/idf_intro.html;	30.	https://	nbcp.in1touch.org/document/2266/Drug%20	Interchangeability%20document%20July%2031%202014.
pdf;	31.	https://	novascotia.ca/dhw/pharmacare/interchangeable-products.asp;	32.	https://www.nspharmacists.ca/wp-content/uploads/2016/05/
Prescribing	StandardsOfPractice.pdf;	33.	https://www.ontario.ca/laws/statute/	90p23;	34.	Drug	Product	Interchangeability	and	Pricing	Act	Chapter	
D-15,	Prince	Edward	Island,	2014;	35.	http://legisquebec.gouv.qc.	ca/en/pdf/cs/P-10.pdf;	36.	http://formulary.drugplan.ehealthsask.ca/PDFs/	
TipsonPrescriptionWriting.pdf;	37.	http://www.ramq.gouv.qc.ca/	SiteCollectionDocuments/liste_med/Liste_med_2018_09_27_en.pdf;	38. Maier M,
et	al.	Can J Kidney Health Dis.	2017;23;4:2054358116688227;	39.	Butler	JA,	et	al.	Transplantation.	2004;77(5):769-89;	40.	Williams	AF,	et	al.	J	Ren	
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2016;73:909-20;	43.	Expert	opinion	of	the	Steering	Committee.

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http://www.NTICHE.com https://www.canada.ca/content/dam/hc-sc/migration/hc-sc/dhp-mps/alt_formats/pdf/prodpharma/applic-demande/guide-ld/bio/comparative-bioavailability-standards-formulations-used-systemic-effects.pdf https://www.canada.ca/content/dam/hc-sc/migration/hc-sc/dhp-mps/alt_formats/pdf/prodpharma/applic-demande/guide-ld/bio/comparative-bioavailability-standards-formulations-used-systemic-effects.pdf https://www.canada.ca/content/dam/hc-sc/migration/hc-sc/dhp-mps/alt_formats/pdf/prodpharma/applic-demande/guide-ld/bio/comparative-bioavailability-standards-formulations-usedsystemic-effects.pdf https://www.canada.ca/content/dam/hc-sc/migration/hc-sc/dhp-mps/alt_formats/pdf/prodpharma/applic-demande/guide-ld/bio/comparative-bioavailability-standards-formulations-usedsystemic-effects.pdf https://www.cadth.ca/sites/default/files/pdf/What_Are_Bioavailability_and_Bioequivalence_e.pdf https://www.canada.ca/content/dam/hc-sc/migration/hc-sc/dhp-mps/alt_formats/pdf/prodpharma/applic-demande/guide-ld/bio/comparative-bioavailability-standards-formulations-usedsystemic-effects.pdf https://www.competitionbureau.gc.ca/eic/site/cb-bc.nsf/eng/03798.html https://abpharmacy.ca/sites/default/files/StandardsOfPractice_May2014_v2.pdf https://abpharmacy.ca/sites/default/files/StandardsOfPractice_May2014_v2.pdf https://www.ab.bluecross.ca/dbl/pdfs/ahwdbl_sec1_critint.pdf http://library.bcpharmacists.org/6_Resources/6-4_Drug_Distribution/5016-FYI-Drug_Interchangeability_Update.pdf http://library.bcpharmacists.org/6_Resources/6-4_Drug_Distribution/5016-FYI-Drug_Interchangeability_Update.pdf http://www.cphm.ca/uploaded/web/Legislation/Pharmacy-Practice-Guide/Guide-to-Pharmacy-Practice-Final.pdf http://www.cphm.ca/uploaded/web/Legislation/Pharmacy-Practice-Guide/Guide-to-Pharmacy-Practice-Final.pdf https://www.health.gov.nl.ca/health/ prescription/idf_intro.html https://nbcp.in1touch.org/document/2266/Drug%20Interchangeability%20document%20July%2031%202014.pdf https://www.health.gov.nl.ca/health/ prescription/idf_intro.html https://www.nspharmacists.ca/wp-content/uploads/2016/05/PrescribingStandardsOfPractice.pdf https://nbcp.in1touch.org/document/2266/Drug%20Interchangeability%20document%20July%2031%202014.pdf https://novascotia.ca/dhw/pharmacare/interchangeable-products.asp https://www.nspharmacists.ca/wp-content/uploads/2016/05/PrescribingStandardsOfPractice.pdf https://www.ontario.ca/laws/statute/90p23 http://formulary.drugplan.ehealthsask.ca/PDFs/TipsonPrescriptionWriting.pdf http://legisquebec.gouv.qc. ca/en/pdf/cs/P-10.pdf http://formulary.drugplan.ehealthsask.ca/PDFs/TipsonPrescriptionWriting.pdf http://www.ramq.gouv.qc.ca/SiteCollectionDocuments/liste_med/Liste_med_2018_09_27_en.pdf

Canadian Pharmacists Journal - May/June 2019

Table of Contents for the Digital Edition of Canadian Pharmacists Journal - May/June 2019