Proposed bulk fluids listings for DHB hospitals

A bulk fluids RFT was released in April 2017 to all potential suppliers following careful consideration of the responses to our 2016 consultation on the draft tender list.

This tender process, managed by PHARMAC, on behalf of DHBs, aimed to secure the best possible pricing and ongoing assured continuity of supply for a range of bulk fluids that are suitable for use in DHB hospitals. This consultation outlines the proposed outcome, following careful analysis of the RFT bids received and our clinical advice. To assist PHARMAC with preparing the tender list and providing objective clinical advice on the bids received, PHARMAC established a Bulk Fluids Clinical Advisory Group which met twice during the process.

PHARMAC welcomes all feedback on proposal below. Feedback received by the deadline will be considered by PHARMAC prior to making a decision. Please do not hesitate to contact us if you have any questions on the proposed process or require further information to inform your response. All responses are due by 5 pm, Thursday 16 November 2017.

Feedback sought

To provide feedback, please submit it in writing, preferably by email in the excel file supplied, or as a separate document clearly referencing the item number relevant to each aspect of your feedback, to:

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

Email: andrew.park@pharmac.govt.nz

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 outcome

Appendix One is the list of bulk fluids that we propose to remain (or be) listed and award Hospital Supply Status to from the specified dates and at the specified prices until 30 June 2021 with a 1% DV limit.

Appendix Two contains a list of bulk fluids that we propose to remain listed, but without Hospital Supply Status. PHARMAC is proposing not to award bids for these fluids (which means that they would not be contracted and thus have assurances of continuity of supply).

Appendix Three contains a list of bulk fluids that we propose delisting from 1 May 2018. Once delisted, they would no longer be available for use within any DHB hospital.

Please note:

• All references to ‘listed’ or ‘delisting’ in this consultation mean included or removed from Part II of Section H of the Pharmaceutical Schedule (as applicable). When a product is included it allows its use in or purchase by DHB hospitals; when it is removed, it is not allowed to be used or purchased by DHB hospitals.
• If Hospital Supply Status (HSS) is awarded, it means no other brand of a bulk fluid with the same presentation (or within the ranges tendered if applicable) would be listed in Part II of Section H of the Pharmaceutical Schedule during the HSS period.
• Any bulk fluids that are not listed in Part II of Section H of the Pharmaceutical Schedule could not be used or purchased by DHB Hospitals.  To be used or purchased, an application would need to be made to PHARMAC for a Pharmaceutical Schedule listing (or an exceptional circumstance application approved).

The most significant proposed changes are:

• to delist potassium chloride 30 mmol/l containing intravenous fluids in favour of 20 mmol/l and 40 mmol/l. This is proposed in the interests of increased standardisation of potassium containing fluids both regionally and internationally. Our clinical advice is that there is no clinically significant difference between these fluids.
• to delist all products currently listed as ‘Plasma Volume Expanders’ including hydoxyethyl starch based fluids (Voluven and Volulyte 6%) and succinylated gelatin 4% (Gelofusine). Our clinical advice is that hydoxyethyl starch based fluids are likely to increase mortality and severe renal failure when compared to resuscitation with crystalloids; and that, while there is no direct evidence of associated harm, there is insufficient evidence to support use of succinylated gelatin over alternative fluids.
• to delist the aqueous chlorhexidine containing irrigation fluids, given substantially increased pricing. Our clinical advice is that there is no clinical need that could not be met with other funded alternative products.
• to move exclusively to 3000 ml bags of fluid for irrigation (by delisting the 2000 ml bags). We have consulted with urologists who have stated a preference for 3000 ml bags given the likely volume of these fluids used during each procedure.

We are seeking feedback on any aspects of all three Appendices. This provides a final opportunity to provide information on any items in Appendix Three that we propose delisting that you consider essential, noting any niche uses. To assist us with the consideration of your feedback, please provide the clinical rationale for any suggested amendments.