Proposed bulk fluids for request for tender

Hospital devices

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PHARMAC is seeking feedback from DHB hospitals, suppliers and other interested parties on a draft tender list of intravenous (IV) fluid bags and a range of irrigation solutions, collectively referred to as bulk fluids, to be included in upcoming national procurement activity.

We are planning to release a bulk fluids RFT to all potential suppliers in early 2017. This tender process, managed by PHARMAC on behalf of DHBs, will aim to secure the best possible pricing and ongoing assured supply for a range of bulk fluids that are suitable for use in DHB hospitals. 

PHARMAC welcomes all feedback on the draft tender list included in this consultation. Feedback received by the deadline will be considered by PHARMAC and a yet to be established bulk fluids clinical advisory group prior to making a decision on the final tender list. Please do not hesitate to contact us if you have any questions on the proposed process or require further information to inform your response. 

To provide feedback, please submit it in writing, preferably in the excel file supplied, or as a separate document clearly referencing the item number relevant to each aspect of your feedback. All responses are due by 5pm Thursday 27 October 2016.

Feedback sought

To provide feedback, please submit it in writing to:

Andrew Park
Therapeutic Group Manager
PHARMAC
PO Box 10 254
Wellington 6143

Email: andrew.park@pharmac.govt.nz

Feedback we receive is subject to the Official Information Act 1982 (OIA) and we will consider any request to have information withheld in accordance with our obligations under the OIA. Anyone providing feedback, whether on their own account or on behalf of an organisation, and whether in a personal or professional capacity, should be aware that the content of their feedback and their identity may need to be disclosed in response to an OIA request.

We are not able to treat any part of your feedback as confidential unless you specifically request that we do, and then only to the extent permissible under the OIA and other relevant laws and requirements. If you would like us to withhold any commercially sensitive, confidential proprietary, or personal information included in your submission, please clearly state this in your submission and identify the relevant sections of your submission that you would like it withheld.  PHARMAC will give due consideration to any such request.  

Details of the proposed bulk fluids RFT

In accordance with PHARMAC’s objective (to secure, for eligible people in need of pharmaceuticals, the best health outcomes that are reasonably achievable from pharmaceutical treatment and from within the amount of funding provided), PHARMAC is consulting on a proposal to tender certain bulk fluids on behalf of DHB hospitals and award Hospital Supply Status to products for a period of approximately three years.

Schedules one and two below (also linked above as an excel file) lists bulk fluids that we propose including and excluding from the tender. Any exclusions would be delisted from the Pharmaceutical Schedule once the outcome of the RFT is determined. If delisted, they would no longer be available for use within any DHB hospital.

We are seeking feedback on any aspects of both lists and the proposed tender process. It will be helpful if you could provide information on any items you consider essential, noting any niche uses, as this will assist us during this process.  However, at this stage of the process we are particularly interested in:   

  • any bulk fluids proposed for inclusion (Schedule One) that you deem are unnecessary
  • any bulk fluids proposed for exclusion (Schedule Two) that you deem are necessary
  • any bulk fluids proposed for inclusion (Schedule One) that require amendments to the presentation description
  • any other bulk fluids not mentioned in either Schedule One or Schedule Two that you deem are necessary, and which you consider should be included within the RFT

To assist us with the consideration of your feedback, please provide the clinical rationale for any suggested amendments.

Key aspects of awarding a Tender for DHB Hospital Pharmaceuticals

  • The Hospital Supply Status brand would be the only brand DHB hospitals could purchase (subject to any allowance for alternative brands under the agreed DV Limits) for a period of approximately three years.
  • No other brand of the bulk fluid with the same presentation would be listed in Section H of the Pharmaceutical Schedule during the Hospital Supply Status period.

Expected RFT timeframes

November/December 2016

Establish and convene a first meeting of a bulk fluids clinical advisory group

February 2017

Issue a RFT to all potential suppliers

April 2017

Evaluate RFT responses with additional advice from bulk fluids clinical advisory group on the suitability of each individual product where required

May 2017

Release consultation on RFT outcome

June 2017

Decision and notification

August 2017

Estimated earliest commencement date for new supply arrangements  

Background

Bulk fluids encompass a wide range of IV fluids and irrigation solutions. Bulk fluids are commonly used in almost every area of DHB hospitals, with IV fluids being given to most DHB hospital inpatients. IV fluids are used for maintenance therapy to replace the ongoing losses of water and electrolytes, replacement therapy to correct any existing water and electrolyte deficits (including during resuscitation) and for the administration of some intravenous medicines. The optimal amount, composition and rate of administration for IV fluids vary depending on a patient’s individual needs. Irrigation solutions are sterile liquids used to clean, disinfect, flush or rinse parts of the body. 

Some DHB hospitals require certain bulk fluid presentations that others may not, depending on the unique clinical circumstances of the patients they treat. Often there is considerable debate about the best fluids to use in certain situations, and many accepted practices of fluid prescribing are simply based on historical reasons. These factors combined have led to considerable variation amongst DHBs in their utilisation of bulk fluids.

PHARMAC ran the last competitive process for bulk fluids in 2008/09. With the exception of the sodium chloride and water IV fluid bags specified below, most other bulk fluids remain listed in the Pharmaceutical Schedule subject to an agreement with Baxter Healthcare Limited that resulted from the 2008/09 process, although all exclusivity periods within that agreement have now expired.

A PHARMAC tender decision was recently notified for the below sodium chloride and water items. This decision provided significant savings on many of the largest volume bulk fluids used by DHB Hospitals. An exclusivity period (with a 1% DV Limit) is now in place on these items until 30 June 2019:

Chemical Name

Presentation and pack size

Previous price per bag

Current price per bag

Brand

sodium chloride

inj 0.45%, bag, 500 ml, 18 bags

$5.50

$3.96

Baxter

sodium chloride

inj 0.9%, bag, 50 ml, 60 bags

$3.01

$1.83

Baxter

sodium chloride

inj 0.9%, bag, 100 ml, 48 bags

$2.28

$1.63

Baxter

sodium chloride

inj 0.9%, bag, 250 ml, 24 bags

$3.60

$1.86

Baxter

sodium chloride

inj 0.9%, bag, 500 ml, 18 bags

$1.70-1.77

$1.23

Baxter

sodium chloride

inj 0.9%, bag, 1,000 ml, 12 bags

$1.71-1.80

$1.26

Baxter

sodium chloride

inj 3%, bag, 1,000 ml, 12 bags

$5.69

$7.60

Baxter

water

inj, bag, 1,000 ml, 12 bags

$2.75

$1.59

Baxter

For the bulk fluids listed in Schedule One and Schedule Two of this consultation, DHB hospitals use approximately 950,000 IV fluid bags and 700,000 packs of irrigation fluid annually, resulting in an approximate expenditure of $8.8 million dollars. This is in addition to annual expenditure of approximately $3.5 million dollars on the sodium chloride and water IV fluid bags specified above.  

Schedule one - proposed for inclusion in RFT

Item Number

Route

Chemical

Formulation

Pack

Tender Notes

1

IV

Compound electrolytes

Inj sodium 137-145 mmol/l; potassium 4-5 mmol/l; magnesium 1-1.5 mmol/l; chloride 98-127 mmol/l; acetate 24-34 mmol/l; +/- gluconate, calcium, malate.

500 ml bag

A balanced crystalloid solution mimicking human plasma in its content of electrolytes, osmolality, and pH is sought. Formulation variations will be considered. 

2

Inj sodium 137-145 mmol/l; potassium 4-5 mmol/l; magnesium 1-1.5 mmol/l; chloride 98-127 mmol/l; acetate 24-34 mmol/l; +/- gluconate, calcium, malate.

1000 ml bag

3

Inj sodium 137-145 mmol/l; potassium 4-5 mmol/l; magnesium 1-1.5 mmol/l; chloride 98-127 mmol/l; acetate 24-34 mmol/l; +/- gluconate, calcium, malate; 5% glucose

1000 ml bag

4

IV

Compound sodium lactate (Hartmann's solution)

Inj sodium 131 mmol/l; potassium 5 mmol/l; calcium 2 mmol/l; bicarbonate 29 mmol/l; chloride 111 mmol/l

500 ml bag

 

5

Inj sodium 131 mmol/l; potassium 5 mmol/l; calcium 2 mmol/l; bicarbonate 29 mmol/l; chloride 111 mmol/l

1000 ml bag

 

6

IV

Glucose (Dextrose)

Inj glucose 5%

100 ml bag

Note: To replace 50 ml bag

7

Inj glucose 5%

250 ml bag

 

8

Inj glucose 5%

500 ml bag

 

9

Inj glucose 5%

1000 ml bag

 

10

Inj glucose 10%

500 ml bag

 

11

IV

Glucose with potassium chloride and sodium chloride

Inj glucose 4%; potassium chloride 20 mmol/l; sodium chloride 0.18%

1000 ml bag

 

12

Inj glucose 4%; potassium chloride 30 mmol/l; sodium chloride 0.18%

1000 ml bag

 

13

Inj glucose 5%; potassium chloride 20 mmol/l; sodium chloride 0.45%

1000 ml bag

Not currently listed in the Pharmaceutical Schedule

14

Inj glucose 5%; potassium chloride 20 mmol/l; sodium chloride 0.9%

1000 ml bag

Not currently listed in the Pharmaceutical Schedule

15

IV

Glucose with sodium chloride

Inj glucose 2.5%; sodium chloride 0.45%

500 ml bag

 

16

Inj glucose 5%; sodium chloride 0.9%

1000 ml bag

 

17

IV

Potassium chloride with sodium chloride

Inj potassium chloride 10 mmol/l; sodium chloride 0.9%

100 ml bag

 

18

Inj potassium chloride 20 mmol/l; sodium chloride 0.9%

1000 ml bag

 

19

Inj potassium chloride 30 mmol/l; sodium chloride 0.9%

1000 ml bag

 

20

Inj potassium chloride 40 mmol/l; sodium chloride 0.9%

1000 ml bag

 

21

IV

Barts solution

Inj glucose 4%; sodium chloride 0.18%

1000 ml bag

Not currently listed in the Pharmaceutical Schedule. If listed, restriction will apply

22

IV

Mannitol

Inj mannitol 20%

500 ml bag

Note: To replace 10% 1000 ml bag

23

Irrigation

Chlorhexadine with cetramide

Irrigation soln 0.015%; cetrimide 0.15%

100-250 ml bottle

Note: One size within range sought

24

Irrigation

Chlorhexidine

Irrigation soln chlorhexidine 0.02%

100-250 ml bottle

Note: One size within range sought

25

Irrigation soln chlorhexidine 0.1%

100-250 ml bottle

Note: One size within range sought

26

Irrigation

Sodium chloride

Irrigation soln sodium chloride 0.9%

30 ml ampoule

Currently outstanding in the 15/16 Annual Tender. May not be included in this RFT, depending on the outcome of that process.  

27

Irrigation soln sodium chloride 0.9%

100-250 ml bottle

Note: One size within range sought

28

Irrigation soln sodium chloride 0.9%

1000 ml bottle

 

29

Irrigation soln sodium chloride 0.9%

2000-3000 ml bag

 

30

Irrigation

Water

Irrigation soln water

100-250 ml bottle

Note: One size within range sought

31

Irrigation soln water

1000 ml bottle

 

32

Irrigation soln water

2000-3000 ml bag

Note: One size within range sought

33

Irrigation

Glycine

Irrigation soln glycine 1.5%

2000-3000 ml bag

Note: One size within range sought

Schedule Two - Proposed for exclusion from RFT (and delisting if currently listed)  

Item Number

Route

Chemical

Formulation

Pack

Tender Notes

34

IV

Compound sodium lactate (Hartmann's solution) with glucose

Inj sodium 131 mmol/l; potassium 5 mmol/l; calcium 2 mmol/l; bicarbonate 29 mmol/l; chloride 111 mmol/l; 5% glucose

1000 ml

 

35

IV

Glucose (Dextrose)

Inj glucose 5%

50 ml bag

100 ml bag included

36

Inj glucose 10%

1000 ml bag

500 ml bag included

37

Inj glucose 50%

500 ml bag

Inj 50%, 10 ml ampoule and 90 ml bottle available

38

Inj glucose 70%

500 ml bag

 

39

Inj glucose 70%

1000 ml bag

 

40

IV

Glucose with potassium chloride and sodium chloride

Inj glucose 2.5%; potassium chloride 20 mmol/l; sodium chloride 0.45%

3000 ml bag

 

41

Inj glucose 4%; potassium chloride 20 mmol/l; sodium chloride 0.18%

500 ml bag

1000 ml bags included

42

Inj glucose 10%; potassium chloride 10 mmol/l; sodium chloride 15 mmol/l

500 ml bag

 

43

IV

Glucose with potassium chloride

Inj glucose 5%; potassium chloride 20 mmol/l

1000 ml bag

 

44

Inj glucose 5%; potassium chloride 30 mmol/l

1000 ml bag

 

45

Inj glucose 10%; potassium chloride 10 mmol/l

500 ml bag

 

46

IV

Glucose with sodium chloride

Inj glucose 4%; sodium chloride 0.18%

1000 ml bag

 

47

Inj glucose 5%; sodium chloride 0.2%

500 ml bag

 

48

Inj glucose 5%; sodium chloride 0.45%

500 ml

 

49

Inj glucose 5%; sodium chloride 0.45%

1000 ml

 

50

IV

Mannitol

Inj mannitol 10%

1000 ml bag

 

51

IV

Potassium chloride with sodium chloride

Inj potassium chloride 40 mmol/l; sodium chloride 0.9%

100 ml bag

1000 ml bags included

52

IV

Ringer's solution

Inj sodium 147 mmol/l; potassium 4 mmol/l, calcium 2.2 mmol/l; chloride 156 mmol/l

1000 ml bag

 

53

Irrigation

Chlorhexadine with cetramide

Irrigation soln chlorhexadine 0.015%; cetrimide 0.15%

30 ml ampoule

Small bottles are included

54

Irrigation soln chlorhexadine 0.015%; cetrimide 0.15%

500 ml bottle

Small bottles are included

55

Irrigation soln chlorhexadine 0.015%; cetrimide 0.15%

1000 ml bottle

Small bottles are included

56

Irrigation soln chlorhexadine 0.05%; cetrimide 0.5%

100 ml bottle

 

57

Irrigation soln chlorhexadine 0.05%; cetrimide 0.5%

500 ml bottle

 

58

Irrigation soln chlorhexadine 0.1%; cetrimide 0.1%

100 ml bottle

 

59

Irrigation soln chlorhexadine 0.1%; cetrimide 1%

100 ml bottle

 

60

Irrigation soln chlorhexadine 0.1%; cetrimide 1%

500 ml bottle

 

61

Irrigation

Chlorhexidine

Irrigation soln chlorhexadine 0.01%

30 ml ampoule

 

62

Irrigation soln chlorhexadine 0.02%

500 ml bottle

Small bottles are included

63

Irrigation soln chlorhexadine 0.05%

100 ml bottle

 

64

Irrigation soln chlorhexadine 0.05%

500 ml bottle

 

65

Irrigation soln chlorhexadine 0.5%

500 ml bottle

 

66

Irrigation

Sodium chloride

Irrigation soln sodium chloride 0.9%

500 ml bottle

Small and large bottles are included

67

Irrigation

Water

Irrigation soln water

500 ml bottle

Small and large bottles are included