The Pharmaceutical Society of Trinidad and Tobago (TSPTT) has welcomed the addition of five new drugs to the Chronic Disease Assistance Programme (CDAP) but hopes to meet with Health Minister Dr Lackram Bodoe to discuss further improvements to the national initiative.
TSPTT past president Allyson Pouchet said the society was pleased with the new additions, which she believes will enhance medical outcomes for patients nationwide. She told Guardian Media that the association is awaiting an appointment with the minister.
The revised CDAP list took effect on October 1, following a comprehensive review of the programme’s clinical, operational, and financial performance by the CDAP Review Committee on June 5. The committee’s recommendations included updating the drug list to reflect modern treatment standards, strengthening diagnostic support, and expanding access in rural and underserved communities.
Among the new drugs added are:
Losartan Potassium 50 mg – for hypertension and kidney protection, particularly in diabetic patients
Clopidogrel Bisulphate 75 mg – to reduce the risk of heart attack and stroke
Rosuvastatin 20 mg – a newer, more potent statin for cholesterol management
Sertraline 50 mg – for depression and anxiety
Risperidone 2 mg – for schizophrenia, bipolar disorder, and agitation in dementia
Pouchet said that while the society supports the updated list, pharmacists should have been included in the decision-making process, as they represent a key stakeholder group encompassing the Regional Health Authorities (RHAs), the private sector, and institutional pharmacies.
“We understand his haste to make the change, but we would be grateful if we could be included as the main stakeholder representing pharmacists,” she said. “We drive education, and we would have liked him to include us in future planning as well.”
She also raised concerns about the introduction of Clopidogrel Bisulphate, noting it requires ongoing monitoring to determine the duration of use.
“If general practitioners prescribe it without proper follow-up, that could be problematic,” Pouchet cautioned.
Pouchet questioned the removal of Simvastatin, arguing that while Rosuvastatin is clinically superior, Simvastatin remains cost-effective and widely used.
“A lot of people are already on Simvastatin, and moving everyone to Rosuvastatin might be an economic challenge for the Government. While Rosuvastatin’s benefits are greater, Simvastatin can still deliver good outcomes and should have been retained.”
She described Risperidone as a significant improvement over Sulpiride, and called Losartan an “extremely good choice” given its renal protection and limited prior availability at health centres.
Pouchet also recommended replacing Diamicron (Gliclazide) 80 mg with the modified-release version for Type 2 diabetes, saying it would improve patient compliance and prove more economical.
“Compliance is always better when patients can take one tablet daily instead of remembering multiple doses,” she explained.
However, she expressed concern that general practitioners continue to prescribe certain eye drops still on the CDAP list, stressing that such treatment should only be initiated by specialists.
Founders defend programme’s intent
Reynold Cooper, first vice president of the T&T Association of Retired Persons (TTARP), said the CDAP was originally designed to address a shortage of pharmacists in the public health system. He chaired the committee that implemented the programme in 2003 while serving as acting Permanent Secretary in the Ministry of Health.
“The Government recognised that a patient’s visit should not only be to collect medication but also to receive counselling on its safe and effective use,” he said.
Cooper said there remains a misconception that private pharmacists earn large sums for dispensing CDAP drugs, explaining that much of the remuneration covers counselling services.
Pouchet agreed, noting that while pharmacists are expected to counsel patients, the CDAP contract is between NIPDEC, which manages the programme, and pharmacy owners — not individual pharmacists.
She said demand for CDAP services surged after COVID-19 as financial hardship increased, leaving pharmacists with less time for patient interaction.
“Counselling is critical because patients often struggle to understand how to take their medication properly,” Pouchet said, adding that CDAP accounts for as much as 80 per cent of a pharmacist’s workload in some pharmacies.
Cooper, also a former Head of the Public Service, said TTARP supports the revised CDAP, especially the inclusion of medications targeting kidney disease, diabetes, heart conditions, and mental health disorders.
“The programme benefits older citizens who rely on costly medication, helping them preserve their limited income,” he said. “Partnerships with private pharmacies also make access easier and allow pharmacists more time to educate patients.”
He added that private pharmacy participation has strengthened the counselling component envisioned in CDAP’s design.
“In the public system, three pharmacists might see over 100 patients. Now, with private pharmacies, pharmacists can take the time to counsel each person — not just dispense the drugs,” Cooper said.