Lesson 2: Pharmacist Role in HTA
side of pharmacy, pharmacists could help to
INTRODUCTION
 The role of pharmacists in HTA actually focuses on
the pharmacoeconomic research that evaluates
pharmaceutical services.
 If not for the pharmacist, paano natin ma’aassess
ang pharmacoeconmics. That’s why, the role of
pharmacists in HTA is very vital.
PHARMACIST COMPETENCIES IN HTA AND RELATED
FIELDS
→ advantages of pharmacists over the other healthcare
expertise
1. Drug Expertise
 Being a pharmacists, we are drug experts, in
a way that we know everything about drugs
(mapa-legal man or illegal) → we know their
properties, mechanism of actions, how they
react with the body, how they interact with
other medications, and also their cost-
effectivity
 Dito papasok yung knowledge regarding
cost-effectiveness when it comes to drug
expertise
2. Communication & Drug Information Skills
 Knowledge about drugs → how to take
them, how to not take them, how can they
be dangerous, and etc
 We also have that communication skills
when it comes to patient counseling about
medications → without proper counseling,
we won’t be able to get the optimal effects
of the medications
3. Research & Health Informatics
 We locate or evaluate as well as interpret
and assimilate scientific or clinical evidence
and other relevant information from the
biomedical, clinical, epidemiological, and
socio-behavioral literatures
 Without pharmacists, they won’t be able to
have researches on new interventions
kapag related ang medications
4. Pharmaceutical Policy
 Pharmacists are responsible in different
policies of pharmaceutical compounds
5. Pharmacovigilance
 Pharmacists have different knowledge for
pharmacovigilance → it relates everything
from the detection, assessment,
understanding, and prevention of adverse
effects of any other medications or vaccine-
related problems
 With that knowledge or expertise on that
detect adverse effects kung paano natin sila
maiiwasan and at the same time, kung
paano rin marereduce para mareduce din
yung costs ng medications which is one of
the important aspects of HTA
6. Pharmacoepidemiology
 Which could contribute all information
about drug safety and effectiveness
 Kapag kasi pharmacoepidemiology → this is
drug safety and effectiveness that is not
available from pre-marketing studies,
therefore, pharmacists have the capability
of identifying information
7. Pharmacoeconomics
APPLICATIONS OF HTA IN SPECIFIC PHARMACY
PRACTICE AREAS
1. Drug Selection and Procurement (Hospital- Based
HTA)
 Coordinate and participate in Pharmacy and
Therapeutics Committee (PTC) and HTA to
ensure proper selection of drugs and
technologies and in the maintenance of the
hospital formulary
 Kapag hospital pharmacists ka, ang role mo
sa P&TC is to be the secretary, so doon pa
lang, nakakapagcontribute na tayo sa drug
selection and procurement pagdating sa
hospital-based HTA
 Aside from that, hospital pharmacists are
also responsible for the purchase,
management, and dispensing of sterile
medical devices in the hospital; pharmacists
are also responsible for the procurement of
medications as well as the disposal of
expired or damaged products
 Provide data on key hospital performance
indicators on drug consumption. This can be
achieved through the conduct of
institutional- based drug utilization studies.
Table 3. Pros and Cons of the involvement of Hospital
Pharmacists in Hospital-Based HTA (Results from the journal
article of N. Martelli et al. in the year 2013)
Pros Cons
Interactions with all Lack of medical skills
health professionals
Support for quality Lack of expertise in
assurance health economics
Ability to read and Cannot replace on HTA
analyze the medical unit
literature
 Growing experience in Cannot be assigned  More on medical knowledge:
medical services full-time to HTA pharmacists → more on patient
activities counseling so that is just a
Skills in knowledgeable interaction
pharmacoeconomics  More on medical skills: nurses,
Promotion of hospital- medtech, radtech, and other
based HTA healthcare professionals → kasi sila
yung may physical interaction with
NOTES:
the patient
A. PROS
2) Lack of expertise in health economics
1) Interaction with all health professionals
 “Medyo disagree ako dito, kasi if
 Pharmacists, somehow, educate
we have proper knowledge on
them regarding medications
pharmacoeconomics, I believe na
 Ang pharmacists, all around sila, meron din tayong proper
kasi medications ang pinag- knowledge sa health economics.”
uusapan → kung saang merong (Ma’am Roanne, 2023)
gamot, nandon din si pharmacist;
 This con explains that pharmacists
kung saan may healthcare
are more on specific side of
professional na naghahandle ng
pharmacoeconomics, because
medications, dapat may
health economics is very broad.
communication siya with the
However, kapag nag-continuing
pharmacist
education ang pharmacists, they
2) Support for quality assurance
will have an ample knowledge
 Pharmacists always make sure that about health economics as well.
the medications given to the 3) Cannot replace on HTA UNIT
patients are of the best quality →
 Kasi nga nakafocus lang ang
with that, part na lagi ng trabaho
pharmacists sa drugs or
ng pharmacist na i’check ang
medications
quality assurance
 In reality, wala namang medical
3) Ability to read and analyze the medical
professional na makakapagreplace
literature
ng HTA unit → kasi sa HTA unit,
 As drug expertise, pharmacists are
dapat hand in hand lahat ng
already familiar with the different
medical professionals
medications kaya naman familiar
4) Cannot be assigned full-time to HTA
na rin with the different medical
activities
literature that is related to drug
 Because pharmacist have other
and other health care processes
things to do and work to do na
4) Growing experience in the medical devices
medyo mabigat din for the hospital
 Hindi lang expert ang pharmacists
 This is not that of con din, kasi
sa drugs, expert din sila when it
pharmacists can be part of HTA
comes to medical devices kasi
without being a full-time
sakop siya ng area ng profession
5) Skills in pharmacoeconomics
2. Drug Pricing and Reimbursement Policies (National
 The skills of pharmacists in
Level) → overall
pharmacoeconomics will help
 Government (as a part of the local HTA
identify the most cost-effective
agency)
medications as well as technology
 Guarantee that (local, regional and/or
6) Promotion of hospital-based HTA
national) medical formularies are up-to-
 With those pros, pharmacists can
date and linked to standardized treatment
have the ability to promote
guidelines and protocols and based on the
hospital-based HTA
best available evidence.
B. CONS
 Important din ang drug pricing and
1) Lack of medical skills
reimbursement policies for the
development of social health insurance
 benefit packages (Ex: PhilHealth and other
health insurances)
^ This shows how the scheme of HTA is involved in the
Philippines which is adapted from a lecture from DOH-HTA
UNIT
 In the illustration, there’s a 3 government bodies
that is involved in HTA scheme
o Yung isang government body ay involved
siya sa pre-HTA scheme, which is the
regulatory review for product quality
evalutions (FDA) → wherein they are
responsible for different clinical researches
before marketing a medication, so
kailangan i’ensure muna nila na they have
the best clinical research for the
medication.
o After that, we have market entry approval,
once na namarket na yung medication,
papasok na don si DOH and PhilHealth to
conduct HTA, in here, they will have a
coverage decisions wherein they will try to
assess the cost-effectivity of the
medications or treatments through the
question of “what to pay for?” as seen on
the illustration. Furthemore, kapag
napansin nila that the medication or
treatment is following the guidelines under
this list, then they will go ahead with the
question, “at how much?” will they provide
for that medication. Dito na papasok yung
price negotiation board, wherein they will
assess or decide whether they will continue
the medication or not.
o After that, they will gladly proceed to the
decision making if they will continue the
coverage or not.
PHARMACY SERVICES
 Variety of terms have been associated with
pharmaceutical or pharmacy services in the
literature, including clinical pharmacy services,
cognitive pharmacy services, pharmaceutical care
services, disease-state management, and
medication therapy management (MTM)
 MEDICATION THERAPY MANAGEMENT: a term used
to describe a wide range of services that are
provided by this discipline; dito natin ma-a’assess
kung sumusunod ba sa tamang regimen si patient
 Pharmacy services consist of a variety of functions
performed by a pharmacist that may or may not be
associated by a pharmacist that may or may not be
associated with the dispensing of a particular
prescription order.
o Examples of pharmacy services:
 Pharmacokinetic monitoring using
algorithms to estimate blood
concentration of medications
 Patient education in order to
improve medication taking
behavior of each patient, so that is
through patient counseling and
drug use monitoring
DIFFERENT PHARMACY SERVICES
1. Clinical Pharmacy Services
 Attempts to promote rational drug therapy that is
safe, appropriate and cost-effective
 Clinical Pharmacists work directly with physicians,
other health professionals, and patients to ensure
that the medications prescribed for patients
contribute to the best possible health outcomes.
 Clinical pharmacists have direct interaction with the
patient as well as with the physicians → contributing
with the better coordination of health care
 Clinical pharmacists are also educated and trained in
many direct patient care environments including
different medical centers, clinics, and variety of
other health settings
 Clinical pharmacists have internships wherein they
will have a rounds with the doctors and decide on
the medication they will give on patients
 ASIAN HOSPITAL AND MEDICAL CENTER, ST. LUKE’S
MEDICAL CENTER → merong clinical pharmacists
accdg. kay ma’am
 In the US, they require 5 years of pharmacy
education → so ginagamit ang mga tao don,
ginagamit nila ang clinical pharmacy as their 5 th year
of pharmacy education because it is an additional
degree for the pharmacy degree
DIFFERENT RESPONSIBILITIES OF A CLINICAL PHARMAY
SERVICE
1. Assess the status of the patient’s health problems and
determine whether the prescribed medications are
optimally meeting the patient’s needs and goals of
 care
2. Evaluate the appropriateness and effectiveness of the
patient’s medications
3. Recognize untreated health problems that could be
improved or resolved with appropriate medication
therapy
4. Follow the patient’s progress
5. Consult with the patient’s physicians and other health
care providers in selecting the medication therapy
6. Advise the patient on how to best take his or her
medications
7. Support the health care team’s efforts to educate the
patient on other important steps to improve or
maintain health
8. Refer the patient to his or her physician or other DISEASE-STATE MANAGEMENT
health professionals  The concept of reducing health care costs and
improving quality of life for individuals with chronic
conditions by preventing or minimizing the effects of
2. Cognitive Pharmacy Services and Pharmaceutical Care the disease through integrated care
Services  The different disease management programs are
 This is more on the knowledge of pharmacist → they designed to improve the health of patients with
are capable of providing pharmaceutical care chronic conditions and reduce associated costs from
services avoidable complications by identifying and treating
 Cognitive pharmaceutical services can be considered chronic conditions more quickly and more
as a strategy to improve the quality of drug therapy effectively, thus, slowing the progression of those
and health care delivery system → the use of diseases
specialized knowledge by the pharmacist for the  A system of coordinated health care interventions
patient or health professionals for the purpose of and communications for defined patient populations
promoting effective and sale drug therapy. with conditions where self-care efforts can be
implemented.
Community Pharmacy
 Disease management empowers individuals, working
 The first level of contact of individuals of community
with other health care providers to manage their
with health care and thus bringing health care as
disease and prevent complications
close as possible to where people live → na’aapply
Disease management is a proactive, multidisciplinary,
yung cognitive pharmacy through patient counseling
systematic approach to health care delivery that:
kasi with the help of that knowledge, the
1) Includes all members with a chronic disease
pharmacists are able to counsel patient on how to
This is the idea to treat chronic conditions more
properly take the medications
quickly and more effectively, so that the disease
 The role and responsibilities of a community
progression can slow down.
pharmacist has been and continues to undergo
2) Supports the provider-patient relationship
major change across the world → the direction of
and plan of care
this change has been a path towards focusing not on
A pharmacist will deal with both patients and
the medicine itself but the user
healthcare providers, to make them a link
between two even when the interaction is not
DIFFERENT ACTIVITIES INCLUDED ON THE BROAD
linear. For example, the trained pharmacist can
DEFINITION OF COGNITIVE PHARMACY AREA
evaluate medication therapies and identify drug
related problems that will enable them to help
the patients manage their problems. On the
other end of the spectrum, the pharmacist will
educate the physician about the treatment
guidelines based on outcomes that are research
conducted. Therefore, nagkakaroon ng
interaction si pharmacist sa provider and sa
patients.
 3) Optimizes patient care through prevention
and proactive interventions based on
evidence-based guidelines
Dapat lahat scientific
4) Incorporates patient self-management
With proper counseling the patient will identify
or know how to properly take care of
themselves already. And properly take the
medication by themselves.
5) Continuously evaluates health status
6) Measures outcome
7) Strives to improve overall health and quality
of life and lower cost of care
8)
Effects of Disease-State Management:
 Improve the safety and quality of care
 Improve access to care
 Improve patient self-management
 Improve financial cost containment without
sacrificing quality or patient satisfaction
 Enhance efforts to provide health improvement
programs on a population basis.
DIFFERENT PHARMACIST INTERACTION WITH
PATIENTS WITH DIFFERENT DISEASES
1. Depression
 Carry out depression screening services
According to the US, preventive services task
force the screening for depression can help to
reduce depression symptoms that something
that pharmacist can help. For example,
counseling the patient.
 Monitor patients who are predisposed to depression
symptoms because of their medication regimens
There are medication that cause depression, for
example MONTELUKAST - they could trigger the
depression of the patient. Avoid giving
medication that can trigger depression.
 Educate and communicate with patients in print or
verbally.
 Identify symptoms of depression in patients who
avoid seeking medical help because of the social
stigma of mental health issues and then extend
support.
Make them feel that they are welcoming, don’t
force people to open up.
 Make themselves accessible for advice on health
care and depression medication and adherence.
Applicable for patient that are already diagnose
with depression, monitor patient’s compliance
to their medication.
2. Diabetes
 Educate patients about the disease through
educational programs often carried out in a less
formal setting
 Educate patients on how to use blood glucose
monitor equipment at home
 Regularly monitor glucose level both self-tested and
laboratory tested
 Monitor patient compliance with scheduled clinic
and laboratory appointments and prescribed
therapies.
 Provide medication management and review
 Screen for interactions and infrastructure actions for
drug/drug, drug/food, drug/lab and drug disease
- Pharmacist interaction with diabetic patient, as we all know
blood glucose testing are usually offered in pharmacy. For
diabetic patient who do not have establish relationship with a
primary care physician, their option in pharmacist could also
help to provide the a more accessible and less expensive
service. Our role as a pharmacist is to educate the patient
about the disease via educational programs that is often
carried out in a less formal setting.
3. Asthma
 Educate patients about the proper use of inhalation
devices, especially those that are overwhelmed with
diagnosis and treatment plans
 Provide educational programs with an emphasis on
warning signs of asthma attacks, triggers and patient
adherence.
 Conduct a periodic review of the kind of inhaler
technique patients’ use.
 Regularly monitor peak-flow function tests
 Ensure compliance assistance and manage chronic
medication use.
- As pharmacist, we do not only provide asthma patients with
the medication that they need, but also we provide valuable
sources to help them understand the pharmacological agents
for treating and managing their diseases.
4. HTN and Cholesterol
 Offer patients’ blood pressure screenings.
 Assist with medication adherence and prescription
management
 Assist patients with smoking cessation program
 Educate patients about hypertension and
cholesterol, their effect on life and health, and the
common comorbidities and conditions.
 Monitor compliance with diest and exercise
regimens.
 Perform periodic blood pressure and cholesterol
level checks
 Screen for interactions and infrastructure actions for
drug/drug, drug/food, drug/lab and drug disease
- Applicable for Old Age Group who could not maintain
healthy diet. As pharmacist, we could offer blood pressure
screening. We can educate the patient regarding
hypertension and cholesterol, as well as the common
comorbidities that are associated to it.

MEDICATION THERAPY MANAGEMENT

 A distinct service or group of services that optimize
therapeutic drug outcomes for individual patients.
 Not intended to focus on one disease state but
cover the full spectrum of medications on a specific
patient may be taking

Pharmacists:
 Involve in disease management programs in
numerous ways

Role of Pharmacists:
 Assist in the identification of individuals
 Conduct monitoring for specific disease, for
example diabetes, cholesterol, blood pressure
 Provide patient education
 Glucose Monitoring
 Peak flow monitoring
 Assist with medication adherence
 Provide direct patient care
 Evaluate outcomes of programs

Prescription Dispensing - kasi naka’focus lang sa isang

medication product.
Disease Management - kasi specific disease lang ang
I’mmanage.
MTM - hindi naka’focus sa isang condition ni patient,
kino’consider din yung mga iba pang comorbidities. The goal
is to lessen the burden of the patient.