Pharmac's latest moves on what drugs to fund are designed to bring clarity to the wider public. File photo. Photo: 123RF
Pharmac is considering trimming its list of medications awaiting funding, focusing on those that have stayed in the lowest-ranked group for more than two years.
There are more than 120 drugs currently being considered, a number of them are listed multiple times and many have been there for a number of years.
Pharmac director pharmaceuticals Adrienne Martin said the decision will bring clarity to the wider public.
"We heard from people that they often feel left in the dark about whether a medicine will be funded and that they really would value transparency and clarity, even if that means that a medicine won't be funded."
Medicines are funded by the government's Budget allocation. Any funds left over are put towards the most prioritised medicines on the list, she said.
"The order of the list helps us negotiate for medicines in New Zealand so that we can be smart with our money and make our dollars go as far as possible and get as many medicines for people in New Zealand as we can," Martin said.
"There are things coming on the list and things going off when we fund them. Every quarter [Pharmac's clinical advisors] look at those medicines and to see if we've got the ranking right."
The changes are still being consulted on. Martin said the proposal was a two-stage process.
"The first stage is, have we got the approach right? Is the approach to decline medicines from the options for investment list the right approach?
"Then if we've got it right, then we would look on consulting to decline the applications, naming what they are, naming the conditions, explaining a bit about what that might mean, and then seeking feedback from people on that."
Pharmac's Consumer and Patient Working Group chair and long-time advocate Malcolm Mulholland said the decision to trim the list "could be" beneficial.
"The one thing it will do is tell the patient that this drug has no hope of being funded in New Zealand and because of that, they can make alternative arrangements."
"There are certainly a lot of grey areas that we would like to see cleared up for the benefit of transparency and for the benefit of patients.
But he questioned who made the calls on how drugs were prioritised and ranked.
"I've been quite critical about how those decisions are made, even to the point where I think we need to have a national debate if we're going to continue to understand Pharmac. And there are many moral and ethical considerations.
"Are we saying that we prioritise drugs that are lifesaving over those that are life-extending or life-improving? Do we, for example, as a prioritisation process, purely leave a decision by chance? Do we flip a coin? This drug or that drug? Because at the moment, that might be our next best alternative."
Higher cost medicines 'get put to the back of the queue'
Leukaemia and Blood Cancer chief executive Tim Edmonds told Checkpoint while the proposal was fine in its intent, Pharmac were going about it in the wrong way.
"Pharmac have confirmed that this could include medicines that are clinically important, medicines that patients have been waiting many, many years for, they've been on this for a long time but still meet a really important need."
"In most countries most high wealth economies around the around the world, these have been funded."
Edmonds said it was often unclear why medicines ended up on the bottom of the list.
"This list is not medicines that aren't any good. This list is medicines that most other countries are funding, and there's a whole range of factors that get considered about where they rank and the most concerning thing is that one of those factors which they're never transparent about, is that the total impact on Pharmac's budget is a key consideration."
"So if you have a medicine that requires a significant investment, no matter how important it is for patients, that can get deprioritized."
Edmonds said by not disclosing the order of the list, it seemed like Pharmac was prioritising bargaining power over transparency to patients.
"When you're an environment like we are at the moment where there's no new money allocated to Pharmac for them to do their job and fund new medicines, higher cost medicines that meet an important clinical need get put to the back of the queue."
While he acknowledged that Pharmac was in a challenging environment due to the lack of funding, Edmonds said New Zealand was an outlier when it came to funding medicine, spending less than any other OECD country.
"What most other countries do is they say this medicine meets an important need it is absolutely cost effective, and then they will go ahead and fund it. They won't then compare it against the other medicines that have been on the list, simply because there isn't a wait list in other countries."
Some blood cancer patients have been waiting for medicine on the list for up to eight years, Edmonds said.
While he agreed with Pharmac wanting to give patients certainty, he said removing medicines was not the way to do it.
"Pharmac need to be transparent about what those medicines are without removing them from the list, so tell patients what those bottom 10 or 20 percent are."
"If having to pay a little bit more means that we can actually provide patients with the access that they need, let's do that."
"They could just disclose the bottom end of the list, keep them on there and it encourages industry to sharpen their pencil, patients then know whether they can access those medicines in the coming months or years, and they can make those same decisions without the application actually being removed."
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