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2004 November Report of the Auditor General of Canada
November 2004 Report—Chapter 4
Appendix—Follow-up of previous audits
2000 Office of the Auditor General recommendation
2001 Public Accounts Committee recommendation
Our assessment
Progress to date
That Health Canada regularly analyze overrides of warning messages generated by the point-of-service system to determine whether warning messages are effective, whether prescriptions rejected by some pharmacists have been filled by others, and how and why clients with very large numbers of prescriptions are getting through the system.
Health Canada continues to monitor overrides of warning messages and uses that information to determine which provider should be audited.
(see paragraph 4.29)
That Health Canada include a discussion of its analysis of pharmacists' overrides along with subsequent action taken in response to that analysis in its performance reports beginning with the report for the period ending 31 March 2002.
Health Canada has reported in its performance report on the analysis of pharmacists' overrides and action taken.
(see paragraph 4.29)
That Health Canada immediately upgrade the point-of-service system for pharmacies under the Non-Insured Health Benefits Program so that the system provides the dates, quantities, and drugs prescribed of at least a client's last three prescriptions and information on doctor visited.
The data extracted from the point-of-service system in Health Canada have not been updated as requested by the Public Accounts Committee.
(see paragraph 4.34)
In cases where it identifies a significant pattern of inappropriate use of prescription drugs, Health Canada should continue to perform rigorous follow-up with Non-Insured Health Benefits clients, physicians, pharmacists, and professional bodies. Health Canada should ensure that it has the means to implement this action.
That Health Canada implement a centralized analysis of drug use similar to that found in the provinces in order to identify misuse, abuse, and multiple use on a real-time basis.
Clients at Health Canada continue to access large numbers of prescription drugs. Information drawn from the overrides is not used to conduct drug utilization review and monitor patient safety.
(see paragraph 4.33)
That Health Canada develop a policy to guide its response in cases where it is unable to obtain the consent of recipients of Non-Insured Health Benefits to share information on use of pharmaceuticals with health care professionals and make that policy known prior to the implementation of a client consent arrangement under the Non-Insured Health Benefits Program.
Health Canada has discontinued analysis of inappropriate drug use due to privacy concerns, despite the fact that sharing of client profiles is not necessary.
(see paragraph 4.46)
That Health Canada explore ways of facilitating the sharing of information between individual pharmacists and physicians providing services under the Non-Insured Health Benefits Program and report its conclusions to the Committee by 31 March 2002.
That Health Canada ask the government to amend the Privacy Act if necessary in order to clarify that health care providers can share the personal medical information of individuals among other health care providers.
That Health Canada review the option of obtaining specific enabling legislation for the Non-Insured Health Benefits Program that would, among other things, permit sharing of information about client drug prescription patterns among health care professionals, and report the conclusions of that review to the Committee by 31 March 2002.
Health Canada should enforce the contract requirements for audit of pharmacy and dental care providers and reporting by the contractor. The Department should continue to take steps to strengthen verification of claims and audit of providers.
That Health Canada include the evaluation plans for community health programs and the Non-Insured Health Benefits Program in its Report on Plans and Priorities, beginning with the report for the fiscal year 2002–03.
Health Canada has taken steps to address overpayment. Next-day claim verification and pharmacy audits have resulted in the prevention, detection, and recovery of overpayment.
(see paragraphs 4.99 and 4.102)
1996 Office of the Auditor General recommendation
2001 Public Accounts Committee recommendation
Our assessment
Progress to date
Veterans Affairs Canada should develop and implement a plan to realize the benefits of the revised drug formulary and improved drug-monitoring system.
Veterans Affairs Canada completely overhauled its formulary and implemented a claims processing system in 1997–98.
(see paragraph 4.31)
Veterans Affairs Canada should explore less costly means of providing over-the-counter medication to clients.
The Department has explored less costly means of providing over-the-counter drugs but has not implemented a process that would lead to significant cost savings.
(see paragraph 4.93)