This is the text extract for InPHARMation: December 2006, browse documents here.

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PHARMAC

Inpharmation

December 2006

From the Chief Executive

We’re reflecting on a successful 2005/06 year and looking towards the challenges ahead.

During the year we have seen New Zealanders’ access to medicines continue to improve, with 14 new medicines funded and a total of 41 new investments being made in medicines. Prescription numbers are still rising too, with 28.5 million dispensed in the 2006 year – an all-time high. Giving people access to funded medicines is PHARMAC’s core role, but funding is really only part of the medicines supply mix. What happens once a medicine has been dispensed for people to use is the most crucial part, and the area where evidence suggests there is scope for significant improvement. This area – the `optimal use’ of medicines – looms as a significant challenge for the health sector as a whole, from patients, pharmacists and doctors through to agencies like District Health Boards and PHARMAC. It is an area where, collectively, we have much to gain. PHARMAC and other health sector agencies are already undertaking innovative work to promote optimal use of medicines, but there is much more to be done. This is not about the level of money spent on drugs, it is about

“PHARMAC and other health

sector agencies are already undertaking innovative work to promote optimal use of medicines

”

making whatever level we do spend go as far as possible. This is an area that PHARMAC is involved in, but the best results will come through a team effort, involving well-informed patients, pharmacists, prescribers, PHOs and other health agencies. In addition to funding medicines, our work in `optimal use’ is through our work in promoting campaigns like Wise Use of Antibiotics, and One Heart Many Lives. In some cases responsible use involves taking more medicine; in others it means taking less. In this issue of inPharmation, we look closely at the concept of `optimal use’ of medicines, and how the sector can work together to ensure medicines aren’t overused, underused or misused.

Matthew Brougham, Chief Executive (Acting)

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Making the best use of our funded medicines

If you have half-empty bottles of pills in your bathroom cabinet, you’re not alone. Figures from a US-based medicines thinktank show that half of New Zealanders prescribed medicines don’t use them according to directions, and don’t always understand the side effects of medicine. This often means people aren’t getting maximum benefit from their doctor’s prescribing decision. The figures indicate that there is room for improvement in the way New Zealanders use prescription medicines. Changing this pattern will take time, and will involve co-operation and improvements across the health sector, from agencies like PHARMAC and District Health Boards, PHOs, doctors, pharmacists and patients themselves. For its part, in addition to its traditional role of funding medicines, PHARMAC develops patient information campaigns and resources to help people understand how to make the best use of medicine. In some instances this involves taking less medicine, as the Wise Use of Antibiotics campaign has achieved since 1999 (see graph below). Not taking medicine at all can sometimes be the best response, and supported through initiatives like the SPARC-developed Green Prescriptions programme (jointly funded by PHARMAC). In others, taking more medicine is the right response, and this is one of the aims of PHARMAC’s One Heart Many Lives campaign, which encourages people to take steps to reduce their risk of having a heart attack or stroke. PHARMAC has been involved in the Wise Use of Antibiotics campaign since 1999. The chart below shows the change in prescribing patterns that have occurred.

Prescriptions 1,400,000 1,200,000 1,000,000 800,000 600,000 400,000 200,000 0 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 Year ending 30 June Drug cost Amoxycillin Drug cost Amoxycillin Clavulanate Prescriptions Amoxycillin Prescriptions Amoxycillin Clavulanate

One Heart Many Lives

Nationwide, Maori and Pacific men die 10 years earlier on average than their non-Maori peers. In some parts of the country, this disparity is even greater, such as in Northland where Maori men die on average 14 years sooner. One Heart Many Lives aims to change this through raising awareness, encouraging men to get their hearts checked, make changes to their lifestyle and, where they need to, take medicine to reduce their `cardiovascular risk’. Optimal use of medicines is central to reducing cardiovascular risk. Medicines such as cholesterol-lowering statins and blood pressure drugs need to be taken regularly and longterm so their benefits can be fully realised. Over the past four years there has been rapid growth in the prescribing of statins, although there are still differences in the way they are prescribed for Maori and Pacific men, compared to other New Zealanders. In Hawke’s Bay, One Heart Many Lives has developed as a partnership between PHARMAC, the DHB, PHOs and local health providers. The impacts of heart disease are long-term and it will take time to turn around the `lifestyle ship’, but some of those involved with the programme have already shown dramatic results. The Northland campaign is now underway, with PHARMAC again supporting the efforts of the DHB and the Northland community in finding responses to the effects of heart disease that will work for their community.

Antibiotics

Cost (millions) before rebates $14.0 $12.0 $10.0 $8.0 $6.0 $4.0 $2.0 $0.0

– Success Stories

Green Prescriptions is a SPARC initiative to encourage people to become more physically active, and is jointly funded by PHARMAC. Physical activity is a recommended treatment for people at risk of cardiovascular disease or Type 2 diabetes, and even for some respiratory conditions. It can even help people give up the medicines they have become dependant on. The programme has close links to initiatives like One Heart Many Lives, and has been shown to be a very effective way to encourage people to become more healthy. SPARC highlights a number of success stories on its website – go to http://www.sparc.org.nz/getting-active/ green-prescription/success-stories.

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Staff in

Myths and realities: The Pharmaceutical Budget

There’s been a lot of discussion about the way spending on pharmaceuticals takes place in NZ. Here’s a quick guide to PHARMAC and the medicines budget:

– Adam McRae

“The pharmaceutical budget doesn’t really exist”

Status: Fact. PHARMAC itself doesn’t spend any money on medicines – DHBs do. Every time a medicine is dispensed, pharmacists make a claim to HealthPac, with the funding ultimately drawn from the DHB where the pharmacy is. Imagine having a chequebook where all your friends can write out the cheques – but you still have to make sure to keep within a budget. PHARMAC estimates the spend, but New Zealand’s 3500 doctors are the ones who “write the cheques” – every time they issue a prescription.

“Australia spends more per capita than NZ, so it must be doing better”

Status: Myth. New Zealand medicine prices have been falling, while the amount of medicines used continues to rise. This means we get more `bang for the buck’ than the Aussies. Overall, New Zealanders have similar access to medicines as Australians.

“PHARMAC underspending is a missed opportunity”

Status: Myth. Any money not spent in the pharmaceutical budget is available for us by DHBs in other health areas. PHARMAC seeks to manage the budget as close as possible to the allotted level, but this can be difficult due to a range of estimation difficulties and practical complexities. Some commentators have described getting close to budget as “landing a 747 on a postage stamp”. PHARMAC is legally required to come within budget, so an underspend is, in principle, required.

“PHARMAC is sitting on a $600 million mountain of money”

Status: Myth. PHARMAC doesn’t hold any funding for medicines – it negotiates subsidy levels and calculates how much medicine will be used, and tries to meet a budget target on behalf of DHBs.

Adam is part of PHARMAC’s Demand Side team, promoting the responsible use of medicines. He has played a central role in the development of One Heart Many Lives into the Northland region. Adam’s role at PHARMAC builds on earlier roles in the health sector. After graduating from Auckland University with a Bachelor of Commerce, he volunteered as an emergency ambulance officer. He returned to university for his nursing degree, and then worked with the Order of St John as an ambulance officer. Adam loves his role at PHARMAC, focusing on patient needs. As a nurse, he learnt that people are often unaware of how to manage their illnesses, so he finds it rewarding to be developing resources that can be a real help.

“Prescription numbers have reached a record high”

Status: Fact. 28.5 million prescriptions were funded last year – the highest number ever recorded. NZers’ access to medicines is improving as more medicines are funded, and cost barriers are lowered through the Government’s primary healthcare strategy. The 4.5% increase in the number of funded prescriptions is roughly in line with the annual average, but the numerical increase – about 1.3 million prescriptions – is significant.

“PHARMAC doesn’t increase its budget enough each year”

Status: Myth. The pharmaceutical budget is set each year by the Minister of Health, who takes into account recommendations from PHARMAC and DHBs. As DHBs continue to hold the funding, they have to decide what portion of their budgets to allocate to community pharmaceuticals, and weigh this against other health needs such as surgery, mental health services or funding for PHOs.