Pura Angela Co, MD, ISPOR Philippines, ThinkWell Philippines, Richard Simon Binos, MS, ISPOR Philippines, Pharmaceuticals and Healthcare Association of the Philippines, Teodoro Padilla, MBA, ISPOR Philippines, Pharmaceuticals and Healthcare Association of the Philippines
ISPOR Philippines, the Pharmaceutical and Healthcare Association of the Philippines (PHAP), and the Philippine Alliance of Patient Organizations (PAPO) recently hosted an online multi-stakeholder dialogue July 8 to discuss the new health technology assessment (HTA) policies and processes that have been put in place as part of the mandate of the Universal Healthcare (UHC) Act. The goal of the forum was to arrive at a better understanding of these new policies, discuss opportunities and challenges in meeting these new requirements and facilitate identification of collaborative solutions that can be adopted.
The UHC Act or Republic Act (RA) No. 11223 signed in 2019 mandated the institutionalization of HTA as a fair and transparent priority mechanism for the development of policies, programs, as well as benefit packages or entitlements covering medicines, procedures, and health services (1). Since its enactment, the HTA Council (HTAC) was created, supported by a secretariat and technical unit (HTAU). A new Administrative Order was also released by the DOH on the implementing guidelines that will guide the funding allocation and coverage decisions in support of UHC (2).
Ms Anne Julienne Genuino-Marfori of the HTAU presented on the status, limitations, and challenges of HTA processes in the Philippines including the General HTA process, expedited, urgent HTA process and minor application. The expedited HTA process has been activated because of the urgent need to review technologies related to the COVID-19 response. Unfortunately, this has also impacted timelines for the general HTA process especially for those needed to meet the mandates of the new law. As of this writing, topic nominations have been deferred to March 2022 (3).
The HTAC and the HTAU also assures the body that it has taken a consultative, collaborative, multi-stakeholder approach. From the drafting of the HTA process and methods guide, the development of the HTA roadmap, up to the monitoring and evaluation program, the HTAC and HTAU have conducted various individual and group stakeholders’ consultations to ensure that HTA is on the right track and addresses the Filipino people’s needs for broader access to health products and services.
As lessons for the group, Dr. Kevin Haninger of PhRMA also discussed the results of a study on the review of international HTA systems and the patient perspective. The objectives of the study are to benchmark HTA systems across multiple dimensions and understand global challenges and inform advocacy on the development of HTA methods and processes. Some of the parameters that were looked at include Institutional Independence, Transparency of Assessment and Decision-Making Processes, Base Assessment Methodology among others.
The stakeholder dialogue was able to draw out queries and concerns on the HTA process from different groups – from medical societies, hospital groups, pharmaceutical industry, program managers, local government units, academe, and research groups, including international organizations and developmental partners. While certain concerns need clarification, some key issues raised will need further discussion to ensure smooth implementation of the HTA process, such as: use of clinical practice guidelines, operationalization of the HTA Research Network, requirement of Phase IV clinical trials, use of real-world data/evidence, use of ICER thresholds, especially for cancer and orphan drugs.
There continues to be many questions in the process of HTA in the Philippines. But with the approach taken by the HTAU and HTAC, and with continuous support by various stakeholders, the Philippines may emerge as a strong HTA implementor in the region. As of writing, a second dialogue is already in the works, being led by the HTAC and HTAU where the aim is to address the issues raised from the previous multi-stakeholder consultation.
References
- Section 34 of RA 11223
- DOH AO #0041 s 2020. https://dmas.doh.gov.ph:8083/Rest/GetFile?id=657396
- DOH DC #337 s 2021. https://dmas.doh.gov.ph:8083/Rest/GetFile?id=691443