This is the text extract for Inpharmation: August 2009, browse documents here.

---

AUGUST 2009

Pharmaceutical budget up 6.3%

We’ve welcomed a 6.3% increase in the pharmaceutical budget, a helpful increase that we think will help ensure people continue to have improving access to medicines. Minister of Health Tony Ryall has approved the community pharmaceutical budget – for medicines used in the community – for 2009/10 at $694 million. This is a $41 million increase on the previous year, and is made up of a $31 million funding top up, plus $10 million of funding transferred from District Health Board budgets. The $31 million of top up funding, plus a further $9 million for use by DHB hospitals, makes up the Government’s $40 million increase in medicine funding. New Zealanders’ use of medicines continues to grow, because of an ageing population, easier access to doctors, wider access to funded medicines and lower dispensing fees. These factors help drive an increase in the volume of medicines prescribed, which in turn drives pharmaceutical expenditure.

Combined with our ongoing savings programmes, the funding increase will help ensure we can continue to fund the medicines already available, while also being able to make significant investments in new medicines.

PHARMAC is already well advanced in allocating how the money will be spent, adding new treatments for cystic fibrosis, hepatitis B, leukaemia and auto-immune disorders to the Pharmaceutical Schedule since the 1 July start of the 2009/10 financial year. Details on some of these decisions are outlined later in this edition of inPharmation. The approval of the pharmaceutical budget is a feature of PHARMAC’s 2009/10 Statement of Intent, which outlines our work programme for the year ahead. The document – available at www.pharmac.govt.nz or via Pharmac Online (see later in this inPharmation) – also outlines some of the challenges PHARMAC faces and how they will be addressed. Challenges include the increasing cost of new medicines, public acceptance of generic medicines, and the challenges posed by current economic conditions. In the current economic climate, a continued focus on budget management, and getting more for less through the use of generic medicines, will continue to be important.

---

PHARMAC - August 2009 Newsletter

Together with Plunket and the Paediatric Society, we have produced a brochure for parents: Practical Tips for Giving Medicine to Kids.

Anyone who has tried giving medicine to a toddler knows the challenges, so the brochure provides advice on how to deliver the medicine (such as letting them use a straw for oral liquids, or combining tablets with yoghurt or another easy to swallow food). We’ve had feedback from parents who say they have found the brochures useful and practical. You can pick up a copy from your pharmacy or local health clinic.

Pra c for tical t ips giv i to kids ng med icin e

Havin g trou ble g etting your child to tak e the ir me dicin e?

PHARMAC online

We’ve moved to set up an online “shop” where people can order brochures, posters, documents and other resources we produce. It’s not a shop in the true sense – because we don’t charge for the materials we produce. But it is set up in the same way as online shopping websites. The site is www.pharmaconline.govt.nz. On the site you can look for materials we have, order them and have them delivered to your address. You can also track your orders and register with the site so you are notified when new materials become available. The online service replaces a fax-back service we have been using to enable health practices and pharmacies order our resources. Through the site you can order materials produced as part of our campaigns such as Wise Use of Antibiotics, One Heart Many Lives or Space to Breathe, plus our corporate documents like our Annual Report, Statement of Intent, PHARMAC Information Sheets and our Annual Review.

Te Whaioranga website

Consumer engagement

We have begun work to review the Terms of Reference for our Consumer Advisory Committee (CAC). This was work identified as part of the medicines strategy Medicines NZ, and is a chance for us to look at how this important committee should best operate. The first stage of this review process was to seek information from people about how such a committee should operate. The feedback we received will be used to help inform a consultation paper which we will be issuing in the near future. The CAC performs an important role in ensuring PHARMAC thinks about the impact its work has on consumers. The work is aimed at ensuring the continued effectiveness of the committee.

PHARMAC has created a new online gateway for information on Māori health – Te Whaioranga (www.tewhaioranga.co.nz).

In developing the site, we surveyed Māori to ask what they wanted from an online health resource. The survey told us that most people wanted to know how people are managing their health, and the associated success stories of whānau in their journey of maintaining and enjoying hauora. Te Whaioranga contains information on Māori health for whanau and health professionals. This includes stories about people’s individual health experiences, information about Māori health priority areas, and answers to commonly-asked questions about taking medicines.

Chi ldr en c the an y le be g arn oo

ps Get y our c hild t – put o lie w the p ith rescri the n bed n their head ose in yo drops and when umber of drops ur lap and your will sp their c in the read ey like m hild opens c Tab agic! their e orner of th es closed lets e eye yes an /ca near d blin Chec psu ks the k with les eye your table pharm t or p acist ull ap they’r firs art a c e sup apsule t to make posed the p sure – s t rotec tive c o do or ma ome medic it’s okay t oatin o cru y irrit Help t g. sh a ate th ines may n ablets e stom ot do s or yo the jo ach if ghurt lip down i b you b n a sm . reak u all sp p Liqu oonfu ids l of ap ple-sa Use a uce, ic pro e crea measu per medic m, ine cu re up the d p or o norm ose o ral sy al kitc f med ri hen t You s icine – nge to easpo hould d on as be ab it’s no on’t use a le to g It’s im t an et an porta oral sy exact me nt tha presc asure ringe t child rib . from ren ta proble ed. Let you your ke th pharm r ms w eir m ith yo doctor kn acist. edicin ow if ur ch es as th ild’s m edicin ere have b they’re een e takin g.

Giv ing m

Practical tips for kids brochure

Eye Dro

For any

With d m to a little be. edic ine creati medic tak vity, in ers childre e taking an parents & if easi n. er exp caregivers can m erien • Be c ce fo o r them ake their nfide childre nt, kin selve s as w d an n’s • L et yo d firm ell as abou their Eve ur chil t m edicin n if he d know w hen y e takin /she f direc ou usses, g. ted. the m are ready to giv edicin e t e still n heir m eeds edic to be given ine. as

• Sta y c me alm and firm dic – but half ine. If they are p never forc an ho e you ersiste ur. r c nt in r • If a efusin hild to tak do e g, try nex se is misse again their d, skip t dose after when the m abou it is d issed t • Exp dose ue. D lain to and c o not your bett ontin doub child t er – d ue wit le dose hat th on’t c h the . e med all the • Rev ic med erse p icine a ine is to m sycho and th ake th treat. logy – em fe ey’re tell y (de only a el our c pend llowe hild it’ d to s a ve this w ing on the ry spe dosin have it tw orks a cial m ice/th g tim nd m e etable akes th ree ti mes a dicine ) e chil day d eag – it’s amaz ing h er to ow oft take it ! en

fur call H the ealth r ad lin Plun v ketLin e toll free ice on e toll fr ee on 0800 611 116 o 0800 r 933 9 22

Giv in

edic • You ines co to arm uld wrap y bab s gett our b ies a ing in the w by gently i • Use ay o an f your n a towel/ oral m mo wrap medic edicin uth o to sto ine e s givin nto th yring p bab Usu g. e and e insi y’s all de ch squir mo y baby wil eek w t a littl l swall uth. here t e med ow if here icin the sy a e into • Av ri the nge is re no bitte oid r tast far en is n mixing m e bud ough edic ot s. back me finished, th ine in you in th dicin e e ba e w by wil r baby’s bo – c l not heck w ith a small get th ttle becau amo ith yo se if th e righ un ur do • Ge t do e bott ctor o t of formu ntly le str la/bre se. Mixing r pha rmac t ast m necess oke their ist. ilk ma he thro ary . at do y be o wnwa k rd to h elp w ith sw

S

pla edic • i ns Give a ine: abo ‘chase ut me r’ o the f so dic tas app ine, such a mething t te h s a te le or o aspoo e child like range s afte n of c juice • Le r h or bre takin ocola t yo g the te ast m befo ur child su ilk/bre sauce or ck re tak a drin ast fe ing th on an ice k of ed. e m • G edicin block to n et you umb t e. r ch ord he ta er to d ild to hold ste bu his/h ull th ds er n e s If y our ch of t he m ild com

---

PHARMAC - August 2009 Newsletter

FORUM

Generics survey

We want to better understand people’s concerns around generic medicines, as part of work we are doing to improve the way brand changes are implemented. To help us understand peoples’ views, we commissioned a survey through Colmar Brunton to ask people about generic medicines. This is an issue that has been highlighted by some recent largescale medicine brand changes. Generic medicines are the off-patent versions of medicines. When medicines are off-patent, it means more than one company can manufacture and sell them. For PHARMAC, this means we can generate competition among companies to get the best deal for New Zealand. Before we can fund any medicine it must first be approved for use in New Zealand by the Government’s medicines regulator, Medsafe. The survey told us that pharmacists were the most common source of information about generic medicines, but that doctors are the most trusted source of information.

The PHARMAC Forum is a chance for people with an interest in our work to give advice on how we can do our job even better. It’s also an opportunity for people to find out a bit more about us and what we do. The Forum is a day-long event involving presentations by PHARMAC and interactive discussions with attendees. Topics being covered at the 2009 event include:

• how medicine brand changes can be improved for patients and health professionals; • `demystifying’ PHARMAC’s economic analysis of pharmaceuticals; • what changes are needed to improve PHARMAC’s engagement with consumers; and • why PHARMAC promotes the optimal use of medicines.

The 2009 PHARMAC Forum will be held in Wellington on 9 October. Anyone can register, and it’s free. Registrations are being taken online at www.pharmac.govt.nz/forum.

When asked, people said their main concerns were: • whether the new brand would work the same as the original brand • whether the new brand was as safe as the original brand

For some people – mainly those who had not had a change of brand, the country where the medicine was produced was also a concern. One of the most interesting findings was that people who hadn’t had a brand change had more anxieties than those who had experienced a change. It seems that, for many people, the concerns go away once they start taking the new medicine. More and better information (including side effects) was identified as the main thing that would help overcome people’s concerns. When prompted, 80% of people with concerns said information about New Zealand quality and safety checks, or evidence that the core ingredients were the same, would make them feel better about the new brand. We will use the results of the survey to improve the way we manage brand changes and communicate them to health professionals and patients. We already produce information for health professionals and patients to help them adjust to brand changes. We will continue to do this and also continue to improve the effectiveness of that information.

---

PHARMAC - August 2009 Newsletter

Medicine funding

The commitment of additional funding for pharmaceuticals in 2009/10, together with PHARMAC’s ongoing savings programmes, has seen a number of decisions made to give people improved access to funded medicines. Some of the recent major decisions are outlined below. Entecavir - new treatment for drug resistant hepatitis B Entecavir (Baraclude) is funded under Special Authority as a first line treatment option for people with hepatitis B. Entecavir is as effective as the currently-funded first line antiviral treatment lamivudine, but has lower rates of resistance. This makes it a useful alternative to lamivudine. Funding entecavir adds to other treatment options PHARMAC has recently funded for people with hepatitis B. In April 2009, PHARMAC widened access to pegylated interferon alpha, adding to the existing funded treatments of interferon, lamivudine and adefovir dipivoxil. PHARMAC expects up to 150 new patients per year will benefit from funded access to entecavir. Dasatinib - new leukaemia treatment Dasatinib (Sprycel) is a newly funded treatment for chronic myeloid leukaemia, a relatively rare form of leukaemia with about 40 new cases diagnosed in New Zealand each year. PHARMAC’s clinical committees identified a need for a drug to treat people who can’t take, or become resistant to, the funded treatment imatinib (Glivec). About 220 people are currently treated with imatinib. Although the price of dasatinib is high, PHARMAC negotiated an agreement with the supplier (Bristol-Myers Squibb) which reduced the overall cost through rebate payments. Details of the agreement are confidential. Adalimumab - access widened to `Biologic’ drug Funding adalimumab (Humira) for a number of autoimmune and inflammatory conditions will mean people won’t have to visit hospitals for treatment. Adalimumab is given by an injection people can give themselves. Adalimumab has been available for the last three years for people with rheumatoid arthritis, and is now available to people suffering from ankylosing spondylitis, psoriatic arthritis and psoriasis, and Crohn’s disease. Adalimumab belongs to a class of drugs called TNF-alpha inhibitors, one of a group of so-called ‘biologic’ treatments for autoimmune disorders (also known as autoimmune biologics). The medications are expensive and can cost up to $20,000 per patient per year. PHARMAC negotiated an agreement with Abbott Laboratories that includes price reductions and the listing of a new brand of levothyroxine for thyroid problems (Synthroid). It also includes a price reduction and access widening for the prostate cancer treatment leuprorelin (Lucrin). PHARMAC expects the number of people receiving funded adalimumab (600 for rheumatoid arthritis) to double in the coming year.

PAH - Disabling cardiovascular disease gets funded treatments People with a rare but disabling cardiovascular condition have easier and more consistent access to three funded medicines. The decision to fund sildenafil, bosentan and iloprost means there is now less paperwork for doctors and more clarity over what is funded. Pulmonary arterial hypertension (PAH) is a serious and often fatal condition affecting the heart and lungs. It causes severe shortness of breath which makes even simple daily tasks difficult for people. PHARMAC expects funding for the treatments to cost about $17 million over the next five years. Rituximab – greater access to life-extending lymphoma drug Treatment for a form of lymphoma has taken a forward step with the widening of funded access to the in-hospital drug rituximab (Mabthera). Rituximab is now funded for the first-line treatment of patients with indolent, low-grade, non-Hodgkin’s lymphoma (NHL). Already funded to treat some other forms of lymphoma, the access widening will mean about 200 more patients a year will have their cancer treated using rituximab. The move is a significant one for patients and doctors, given evidence showing rituximab can extend people’s life expectancy. Financially it is also significant, representing an additional spend by DHB hospitals of about $12 million over five years.

PHARMAC is the Government agency responsible for deciding which medicines are subsidised for New Zealanders. It manages spending on pharmaceuticals for the District Health Boards, and ensures that a comprehensive list of medicines (the Pharmaceutical Schedule) is subsidised for New Zealanders, and that the list of medicines continues to grow to meet the needs of patients. Contact: PHARMAC, Level 9, Cigna House, 40 Mercer Street, PO Box 10-254, Wellington 6143, New Zealand Phone: +64 (0)4 460 4990 Fax: +64 (0)4 460 4995 www.pharmac.govt.nz