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PHARMAC Information sheet

Targeting medicines

Why target medicines?

Some medicines treat many illnesses and how they are used is the decision of the doctor writing the prescription. When it comes to funding medicines, we want funding to go to the people who need it most. In some cases, targeting can help us to identify the people who will benefit the most from a medicine. In the same way we assess funding suitability, we must also assess what is appropriate access for that medicine. If unrestricted access results in inappropriate use, money is wasted and that means there is less funding available for other medicines or health services.

Special Access Programmes

Exceptional Circumstances

Exceptional Circumstances (EC) is a way of funding medicines that are not otherwise funded in the community or in hospitals. Typically, we receive about 2000 applications for exceptional circumstances funding each year across three schemes: • Community EC - for patients with rare or unusual clinical situations. PHARMAC manages panels of clinicians who make recommendations or decisions, on EC funding. The funding is drawn from the Community Pharmaceutical Budget. • Hospital EC - enables District Health Board hospitals to dispense medicines for people being discharged from hospital. PHARMAC assesses applications on a case-by-case basis with the sole criterion being cost-effectiveness. • Cancer EC - allows DHBs to fund, on application to PHARMAC and where certain criteria are met, cancer medicines that are not otherwise funded.

How do we target medicines?

Here are some of the ways we may target medicines.

Published Guidelines

The New Zealand Guidelines Group (www.nzgg.org.nz) develops best-practice guidelines, including guidance on pharmaceutical prescribing, for a number of conditions.

Endorsement

This requires a prescriber to write on the prescription that their patient meets the criteria for full subsidy. This can be used where a treatment (such as antibiotics) is required urgently.

Special Authority

This is our most frequently used targeting tool. Usually, the published Special Authority criteria define the patients who can receive funding for the medicine. People may first be required to try a less expensive medicine, or the medicine may need to be prescribed by a particular type of doctor. Special Authority applications are processed by Ministry of Health Sector Services (formerly HealthPAC). We’ve worked with them to improve the Special Authority process and now electronic application is possible, which has the advantage of processing applications instantly while the patient is still with their doctor.

PHARMAC Information sheet

PHARMAC is the Government agency that decides, on behalf of District Health Boards (DHBs), which medicines get subsidised so that they are more affordable for New Zealanders and available nationally. The subsidies PHARMAC sets are funded from a fixed budget that is part of DHB funding. PHARMAC also promotes the optimal use of medicines, carries out some procurement for DHBs, and manages special access programmes for some medicines. Information Sheets on various PHARMAC topics are available from our website: www.pharmac.govt.nz/patients/infosheets If you have specific areas of interest (such as consultations, committees or vacancies), visit our website and subscribe to news feeds in the area(s) of interest to you: http://pharmac.govt.nz/feeds

Contacting Us

Call us on 0800 66 00 50 (between 9am and 5pm, Monday to Friday), or on 04 460 4990 (between 8am and 5.30pm, Monday to Friday). Write to us at: PHARMAC, PO Box 10 254, Wellington – we respond to all letters Email us at enquiries@pharmac.govt.nz – we respond to all emails