This is the text extract for Annual Review 2008 - Part 3, browse documents here.

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Heart disease

As outlined on Page 21, PHARMAC maintained full funding for the beta blocker metoprolol, at an additional cost of approximately $4 million. One of the potential funding opportunities this impacted on was a proposal to widen access to the cholesterol absorption blocker ezetimibe. PHARMAC consulted on a widening of access, but with insufficient funds available this did not proceed. The ezetimibe proposal was subsequently overtaken by international studies questioning the effectiveness of the medicine, and has resulted in PHARMAC seeking further advice from its clinical advisory committees. Access was widened to the blood pressure-lowering medicine losartan, a move that will benefit people with heart disease and diabetes. Losartan (Cozaar), and a similar medication that combines losartan with hydrochlorothiazide (Hyzaar), were already funded to treat people with raised blood pressure. The decision saw losartan’s access widened so it can now be used in combination with an ACE Inhibitor when appropriate. In addition, it can now be prescribed to treat the kidney disease that may result from type 2 diabetes, and so help delay progression to kidney failure.

Major decisions

• Improved access to clopidogrel (Plavix) – for cardiovascular risk reduction in aspirin-naïve patients • Subsidy increase for metoprolol (Betaloc) • Wider access to losartan, losartan with hydrochlorothiazide – for patients with renal disease and those with treatment-resistant blood pressure

Agents affecting the Renin-Angiotensin system

Cost (millions) $50 $45 $40 $35 $30 $25 $20 $15 $10 5 $5 $0 0 Jun 93 n 93 Jun 95 n 95 Jun 96 n 96 Jun 98 n 98 Jun 00 n 00 Jun 01 n 01 Jun 03 n 03 Jun 04 n 04 Jun 06 n 06 Jun 07 n 07 Jun 94 n 94 Jun 97 n 97 Jun 99 n 99 Jun 02 n 02 Jun 05 n 05 Jun 08 n 08 0 400 0 200 0 600 0 1,0 , 800 0 Prescriptions (000) 1,2

Cost (ex GST) ACE Inhibitors with Diuretics Cost (ex GST) Angiotension Converting Enzyme (ACE) Inhibitors Cost (ex GST) Angiotension II Antagonists Prescriptions ACE Inhibitors with Diuretics Prescriptions Angiotension Converting Enzyme (ACE) Inhibitors Prescriptions Angiotension II Antagonists

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Anti-ulcerants

PHARMAC continued its strategy of developing generic competition in the high-use area of proton pump inhibitors (PPIs), the most-prescribed medicines for treating gastro-intestinal disorders. Further brands of the two most commonly prescribed PPIs, pantoprozole and omeprazole, were introduced. Omeprazole, with 1.1 million prescriptions in the past year, ranks fourth on the most-prescribed medicines list. Multiple brands of omeprazole were introduced. Omezol was funded from 1 June 2007, and the Dr Reddy’s Omeprazole brand was funded from 1 October 2007. The Dr Reddy’s brand of pantoprazole was funded from 1 January 2008 and became the sole supply brand of that medicine from 1 June 2008. Together, these moves towards generic competition are expected to produce significant savings in a high volume, high expenditure area of the Pharmaceutical Schedule. At the same time, PHARMAC’s Gut Reaction campaign was encouraging medicine reviews of patients prescribed PPIs long-term, and a change to H2 antagonist medicines if appropriate. Overall, there was a continued rise in prescribing of PPIs, which added a further 60,000 prescriptions for the year to 1.26 million prescriptions. Prescribing of H2 antagonists remained steady.

Major decisions

• Sole supply of pantoprozole (Dr Reddy’s Pantoprazole) • Multiple brands of omeprazole (Omezol, Dr Reddy’s Omeprazole, Losec)

Anti-ulcerants

Cost (millions) $80 $70 $60 $50 $40 $30 $20 $10 $0 n 8 Jun 98 Jun 01 n Jun 03 n Jun 05 n Jun 08 n 8 Jun 94 n 4 n 6 Jun 96 Jun 97 n 7 Jun 99 n 9 Jun 00 n 0 Jun 06 n 6 Jun 93 n Jun 95 n Jun 02 n 02 n 4 Jun 04 Jun 07 n 7 0 600 400 0 0 200 0 Prescriptions (000) 1,4 2 1,2 0 1,0 0 800

Cost (ex GST) H2 Antagonists Cost (ex GST) Proton Pump Inhibitors

Prescriptions H2 Antagonists Antagonists Prescriptions Proton Pump Inhibitors Proton t

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Mental Health

The antipsychotic medicine ziprasidone (Zeldox) was funded as a secondline treatment for people with schizophrenia and related psychoses from 1 August 2007. Ziprasidone, another of the newer ‘atypical’ antipsychotic range of medicines, became funded for people who have tried other atypical antipsychotics (risperidone or quetiapine) but stopped using these medicines because of unacceptable side effects or inadequate response. The funding of ziprasidone was progressed to fill an unmet clinical need for an atypical antipsychotic with reduced tendency to cause weight gain. Ziprasidone is the fifth atypical antipsychotic agent to be funded by PHARMAC. About 40,000 patients per year take one of the other four funded atypical antipsychotics (clozapine, risperidone, quetiapine and olanzapine), at an annual cost of over $58 million. PHARMAC provided ongoing funded access to the Ritalin SR brand of methylphenidate sustained-release 20 mg tablets for those people who experienced clinical difficulties in switching from Ritalin SR to Rubifen SR, another brand of methylphenidate which was funded in 2007. Methylphenidate is used to treat Attention Deficit and Hyperactivity Disorder (ADHD), primarily in children. The ongoing access to Ritalin SR followed some patients reporting difficulties to the Centre for Adverse Reactions Monitoring (CARM), the Otago University based organisation that tracks adverse reactions to medicines. About 10,000 people take sustained-release methylphenidate. The number of antidepressant prescriptions continued to rise, with new generation antidepressants adding 70,000 prescriptions during the year. However, overall spending on antidepressants decreased by $10 million compared with the previous year, reflecting the impact of a generic version of paroxetine, Loxamine, which was introduced late in the 2006/07 financial year.

Major decisions

• Atypical antipsychotic ziprasidone (Zeldox) funded as a

second-line treatment for people with schizophrenia and related psychoses

Attention Deficit Disorder

Cost (millions) $2.5 Prescriptions (000) 70 60 $2.0 50 $1.5 40 30 20 $0.5 10 $0

Jun 00 Jun 02 Jun 04 Jun 06 Jun 93 Jun 96 Jun 97 Jun 98 Jun 99 Jun 01 Jun 03 Jun 05 Jun 94 Jun 95 Jun 07 Jun 08

$1.0

0

Cost (ex GST) Methylphenidate - Immediate Release Cost (ex GST) Methylphenidate - Sustained Release Prescriptions Methylphenidate - Immediate Release Prescriptions Methylphenidate - Sustained Release Prescriptions Methylphenidate - Total (adj Sustained Release)

Antidepressants

Cost (millions) $35 $30 $25 $20 400 $15 300 $10 $5 $0 Jun 06 Jun 07 Jun 08 Jun 93 Jun 94 Jun 95 Jun 96 Jun 97 Jun 98 Jun 99 Jun 00 Jun 01 Jun 02 Jun 03 Jun 04 Jun 05 200 100 0 Prescriptions (000) 800 700 600

Antipsychotics

Cost (millions) $60 $50 $40 500 $30 $20 $10 $0 Jun 93 Jun 95 Jun 96 Jun 97 Jun 98 Jun 00 Jun 01 Jun 02 Jun 03 Jun 04 Jun 94 Jun 99 Jun 05 Jun 06 Jun 07 Jun 08 150 100 50 0 Prescriptions (000) 300 250 200

Cost (ex GST) Depot Injections Cost (ex GST) Old Antidepressants Cost (ex GST) New Antidepressants Prescriptions Old Antidepressants Prescriptions New Antidepressants Cost (ex GST) New antipsychotics Cost (ex GST) Old antipsychotics

Prescriptions Depot Injections Prescriptions New antipsychotics Prescriptions Old antipsychotics

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Cancers and transplant medicines

Seven major funding decisions in the past year related to cancer medicines. This was largely made possible by additional funding earmarked for such spending in Budget 2007, much of which targeted cancer medicines used in DHB hospitals. These included oxaliplatin for colon cancer, vinorelbine for lung cancer and paclitaxel for relapsed germ cell cancer, ovarian cancer and node-negative breast cancer. Funding decisions improved treatment options for some of New Zealand’s mostcommon cancers, including lung, colon and breast cancers. The capecitabine decision also provided the opportunity to make savings for DHB hospitals in infusion services, by moving patients from an infusion-based treatment, requiring inpatient treatment, to a pill that could be taken by patients in the community. This helped free up services that could be used for other cancer treatments. The most significant decisions related to oxaliplatin (a further 1000 people per year treated with the drug, worth an additional $27 million over five years), trastuzumab (Herceptin) for early stage HER2-positive breast cancer ($6 million per year), and widening access to vinorelbine for adjuvant treatment of non small-cell lung cancer ($6 million). The listing of exemestane for breast cancer provided a third aromatase inhibitor option on the Pharmaceutical Schedule. In a further decision of benefit to cancer patients, PHARMAC amended the prescribing restrictions on the anti-nausea drug ondansetron when used in cancer patients. The list of medicines available to treat organ transplant rejection grew, with the availability of sirolimus (Rapamune) from 1 July 2007. Sirolimus became available as a “rescue therapy” for people with organ transplants who had not tolerated, or responded to, other anti-rejection treatments.

Major decisions

• Trastuzumab (Herceptin) funded for HER2-positive early

breast cancer (9 week concurrent with a taxane)

• Docetaxel (Taxotere)

– for concurrent use with trastuzumab

• Exemestane (Aromasin)

– for hormone receptor positive breast cancer

• Oxaliplatin (Eloxatin)

– Stage 3 (Duke’s C) colon cancer

• Paclitaxel

– open access (removal of Special Authority restriction)

• Sirolimus (Rapamune)

– for kidney and organ transplant rejection

• Vinorelbine

– adjuvant treatment of non-small cell lung cancer

A summary of cancer medicines decisions is provided in the following table:

Summary of cancer medicines decisions

Medicine For Decision Widened Special Authority criteria to include treatment of Duke’s C colorectal cancer Special Authority criteria widened to be able to be used with trastuzumab for early breast cancer New listing Special Authority criteria expanded to include Stage III (Duke’s C) colorectal cancer Community or hospital

Oncology Agents and Immunosuppressants

Cost (millions) $30 $25 $20 $15 $10 $5 $0

Jun 93 Jun 94 Jun 95 Jun 96 Jun 97 Jun 98 Jun 99 Jun 00 Jun 01 Jun 02 Jun 03 Jun 04 Jun 05 Jun 06 Jun 07 Jun 08

capecitabine (Xeloda)

Duke’s C colorectal cancer

Community

Prescriptions (000) 100 90 80 70 60 50 40 30 20 10 0 paclitaxel Relapsed germ cell cancer of the testis, relapsed ovarian cancer, node-negative HER2 positive early breast cancer HER2-positive early breast cancer (9 week treatment course) exemestane (Aromasin) oxaliplatin (Eloxatin) Breast cancer docetaxel (Taxotere) Breast cancer

Hospital

Community

Stage III (Duke’s C) colorectal cancer

Hospital

Removal of Special Authority criteria

Hospital

Cost (ex GST) Chemotherapeutic Agents Cost (ex GST) Endocrine Therapy Cost (ex GST) Immunosuppressants

trastuzumab (Herceptin)

Special Authority criteria widened to be able to be used for HER2-positive early breast cancer as a 9 week treatment Special Authority criteria expanded to include stage IB-IIIA non-small cell lung cancer

Hospital

vinorelbine Prescriptions Chemotherapeutic Agents Prescriptions Endocrine Therapy Prescriptions Immunosuppressants

Adjuvant treatment of stage IB-IIIA non-small cell lung cancer

Hospital

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PHARMAC in the wider health sector

During 2007-08 PHARMAC continued its purchasing role for DHB hospitals. Existing projects

PHARMAC continued its activity in the area of hospital pharmaceuticals through management of Section H. There were 290 changes to Part II of Section H in the 2007/08 Financial Year, of which 161 were new listings, 107 were price decreases, seven were price increases and 15 delistings. Many of these changes resulted from the annual multi-product tender, with others resulting from negotiated contracts. Tenders accounted for 104 changes, resulting in net savings of approximately $550,000 per annum. Other agreements included a bundle with AstraZeneca resulting in approximately $900,000 savings in 2008, rising to $2.1 million in 2009, and a price reduction for the cancer treatment paclitaxel resulting in savings of approximately $150,000 per annum. PHARMAC also ran a commercial process around recombinant factor VIII, for the treatment of haemophilia, as protections in the previous contracts were due to expire on 1 July 2008. Three agreements were reached, however partly as a result of exchange rate movement over the past few years, pricing overall has increased at a cost of approximately $1 million per annum.

Exceptional Circumstances

PHARMAC administers the Exceptional Circumstances programmes, which enable patients to access medicines not otherwise subsidised. Separate schemes are operated for community (CEC), hospital (HEC), and cancer (CaEC) medicines. CEC provides access to medicines not otherwise funded, for people with rare or unusual clinical circumstances. Access is subject to approval by a panel of clinicians and operates within a sub-set of the pharmaceutical budget. HEC has been running since July 2003. This mechanism enables DHB hospitals to fund medicines in the community that are not funded through the Pharmaceutical Schedule. The sole criterion for approval under HEC is that funding the medicine by the DHB hospital is more cost effective for the hospital than the most likely alternative intervention or outcome. Cancer EC was set up in 2005. This mechanism allows DHB hospitals to fund, on application to PHARMAC, cancer medicines that are not funded through the Pharmaceutical Cancer Treatments “basket” – a list of cancer medicines that all DHB hospitals must fund. Overall, PHARMAC received 2820 Exceptional Circumstances applications during the year, of which 2432 were approved. A breakdown of applications received and processed during the year is provided in the table.

New activities

At the beginning of 2007/08, PHARMAC was investigating the possibility of national contracting for wound care products, cardiac stents, and orthopaedic joint prostheses. However, in September 2007 the Procurement Steering Group, established by DHBs, advised PHARMAC that it was going to pursue national agreements in the areas of wound care and cardiac stents. As a result, PHARMAC’s work in this area came to an end and the project was absorbed by the DHB group. PHARMAC established an advisory group of orthopaedic surgeons and other relevant clinical staff to advise on procurement of orthopaedic prostheses. Given this is a new therapeutic area for PHARMAC, we put significant effort into ensuring we had the appropriate people advising us on this project, and this included working with orthopaedic surgeons through the New Zealand Orthopaedic Association. We also sought information from DHBs and suppliers. PHARMAC is now working through the advice and information obtained, and expects to come to a recommendation on options by the end of 2008.

Summary of Exceptional Circumstances Schemes

Received CEC CEC (automatic approvals) HEC HEC (automatic approvals) CaEC Totals Initial Renewal Initial Renewal Initial Renewal Initial Renewal Initial Renewal 294 173 842 200 734 406 99 4 621 6 2820 Approved 88 170 842 200 578 397 99 4 48 6 2432 14 0 388 156 9 Declined 206 3

Advisory role

PHARMAC also performed an advisory role to the Ministry of Health in its process to purchase HPV vaccine, and its activity around some emergency supplies of antidotes.

Influenza vaccine

Supply of influenza vaccine continued under agreements formed in the 2006/07 year. Approximately 755,000 doses of vaccine were supplied between March and June 2008, however this includes privately funded use. Overall, about 10,000 more doses than the previous year were supplied. This equates to about $7 million in expenditure (before rebates).

1 A further four applications were on hold, pending the provision of more information

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Hearing from the experts –

PHARMAC’s Advisory Committees

PHARMAC has a number of advisory committees all providing important input to PHARMAC’s work as consumers, clinicians and pharmacists. It’s vital these committees are performing well, and are seen to be performing well, so optimising the advice of our advisory committees has been an ongoing theme during the year. We heard comments during the year that some people lacked confidence in the roles and recommendations of our advisory committees. This came through during the Ministry of Health’s consultation around Medicines NZ, and was also expressed at the PHARMAC Forum in December 2007. During the medicines policy work we heard comment that PTAC shouldn’t take into account cost or cost-effectiveness in its deliberations, and should concentrate solely on clinical effectiveness data. This sounds easy, but they are difficult to separate. Doctors routinely face questions of cost and ‘opportunity cost’ in their daily practice. To not do so is to ignore the reality of health funding in New Zealand. Further, restricting PTAC’s deliberations to just clinical issues would hamper the quality of PTAC’s advice. The release of Medicines NZ in December 2007 identified that the current arrangements work well, however it identified two areas for review; the way PTAC members are appointed, and the way it operates, as defined by its Guidelines. The Ministry of Health is reviewing the PTAC appointment protocol, which defines how members are appointed to the committee by the Director-General of Health. PHARMAC’s review of the committee’s Guidelines (now called its Terms of Reference) saw public consultation on a draft revised Terms of Reference from June 2008. With publication of the new Terms of Reference, changes include: • Publishing more minutes relating to pharmaceutical funding applications on PHARMAC’s website, including when PTAC has deferred making a recommendation. PHARMAC will also begin publishing minutes from PTAC subcommittee meetings on its website. • The Committee’s operations – its membership, scope of activity and specific functions – have also been clarified in a number of ways. For example: • membership can now include senior health professionals, such as public health physicians, pharmacists or nurses – not just medical practitioners as in the past. This change reflects that many types of health professionals, not just doctors, have an interest and expertise in prescription medicines; and • PTAC can now request that a subcommittee undertake a “rapid review”, in order to receive specialised advice from a subcommittee in a more timely way. • The relationship between PHARMAC and PTAC has also been clarified, like making clear that PTAC can provide PHARMAC with any and all information and views it considers desirable. These changes are intended to maintain and improve the relationship and continue PTAC’s tradition of providing objective advice to PHARMAC. Overall, the changes are designed to provide more clarity about the Committee’s role and functions, and to increase public confidence in its operations.

CAC

Consumer Advisory Committee

CAC’s role scrutinised

Some thought our Consumer Advisory Committee was not sufficiently representative of patient groups, and so its views weren’t representative of consumer groups. With over 100 health-related consumer groups in New Zealand, it would be impossible to have all interests represented on the committee, and nor is it necessarily desirable. As defined by its Terms of Reference, the Committee’s role is to provide a consumer perspective, but it’s not intended to be “representative” of consumer groups. PHARMAC gains consumer input in a variety of ways, and the CAC is an important part of that mix. With many hundreds of consumer groups involved in health, it would be impossible to have a Committee that represented the diversity of views those groups have. We already have mechanisms for direct contact with many of these groups. Nonetheless there will be a review of the CAC’s Terms of Reference in the 2009 year and this provides the opportunity to seek external views on the appropriate role, and membership, of this important committee. And as part of our ongoing work in improving communications, we will be seeking to improve people’s understanding of the committee and the role it plays.

Pharmacology and Therapeutics Advisory Committee

Changes with PTAC

Medicines NZ also touched on the relationship between PHARMAC and PTAC – the Pharmacology and Therapeutics Advisory Committee. Fundamentally, PTAC is part of the overall PHARMAC structure and this relationship is made clear in legislation. But PTAC’s members are not part of PHARMAC – they are external experts appointed by the DirectorGeneral of Health. This distinction, and the overall relationship, are clearly made in the committee’s operating rules (now renamed the Terms of Reference).

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Directory

Pharmacology and Therapeutics Advisory Committee (PTAC)

Chair Professor Carl Burgess MBChB, MD, MRCP (UK), FRACP, FRCP, physician & clinical pharmacologist Deputy Chair Dr Paul Tomlinson BSc, MBChB, MD, MRCP, FRACP, paediatrician Committee Members Dr Ian Hosford MBChB, FRANZCP, psychiatrist Dr Sisira Jayathissa MBBS, MD, MRCP (UK), FRCP (Edin), FRACP, FAFPHM, Dip Clin Epi, Dip OHP, Dip HSM, MBS, physician Dr Peter Jones BMedSci, MB, ChB, PhD, MRCP (UK), FRACP, physician Dr Jim Lello BHB, MBChB, DCH, FRNZCGP, general practitioner Dr Peter Pillans MBBCh, MD, FCP, FRACP, physician & clinical pharmacologist Dr Tom Thompson MBChB, FRACP, physician Dr Jim Vause MBChB, DipGP, FRNZCGP, general practitioner (resigned Dec 2007) Dr Howard Wilson BSc, PhD, MB, BS, Dip Obst, FRMZCGP, FRACGP, general practitioner PTAC Subcommittees Analgesic - Dr Howard Wilson (chair, PTAC, general practitioner), Dr Ian Hosford (PTAC, psychiatrist), Dr Peter Jones (PTAC, physician), Dr Rick Acland (anaesthetist), Dr Jonathan Adler (palliative care specialist), Dr Bruce Foggo (palliative care specialist), Dr Lindsay Haas (neurologist), Dr Geoff Robinson (physician), Dr Jane Thomas (paediatric anaesthetist)

The PHARMAC Board

Chairman Richard Waddel BCom, FCA, AFInstD Deputy Chairman Professor Gregor Coster CNZM, MSc (Hons), PhD, MBChB, FRNZCGP Directors Kura Denness (Te Atiawa) MBA CA Dr David W Kerr MBChB, FRNZCGP (Dist), FNZMA David Moore MCom, Dip Health Econ (Tromso), CA Adrienne von Tunzelmann MA (Hons), Master of Public Policy

Anti-infective - Dr Paul Tomlinson (chair, PTAC, paediatrician), Dr Steve Chambers (infectious disease specialist), Dr Iain Loan (general practitioner), Dr Richard Meech (infectious disease specialist), Dr Mark Thomas (infectious disease specialist), Dr Howard Wilson (PTAC, general practitioner). Cardiovascular - Dr Sisira Jayathissa (appointed chair, PTAC, physician), Dr Peter Pillans (Physician/Clinical Pharmacologist), Dr Malcolm Abernathy (cardiologist), Dr Lannes Johnson (general practitioner), Dr Stewart Mann (cardiologist), Dr Richard Medlicott (general practitioner), Dr Miles Williams (cardiologist) Cancer Treatments (CaTSoP) - Prof Carl Burgess (chair, PTAC Chair, internal medicine physician), Dr Bernie Fitzharris (oncologist), Dr Peter Ganly (haematologist), Dr Vernon Harvey (oncologist), Dr Tim Hawkins (haematologist), Dr Andrew Macann (radiation oncologist), Dr Anne O’Donnell (oncologist), Dr Lochie Teague (paediatric haematologist & oncologist) Diabetes - Dr Tom Thompson (chair, PTAC, physician), Dr Paul Tomlinson (PTAC, paediatrician), Pat Carlton (diabetes nurse specialist), Dr Nic Crook (endocrinologist), Dr Tim Kenealy (general practitioner), Dr Peter Moore (physician), Dr Bruce Small (general practitioner), Dr Jim Vause (PTAC, general practitioner)

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Hormone and Contraceptive - Dr Howard Wilson (chair, PTAC, general practitioner), Dr Mike Croxson (endocrinologist), Prof Joh Hutton (gynaecologist), Dr Frances McClure (general practitioner), Dr Christine Roke (family planning), Dr Bruce Small, (general practitioner) Mental Health - Dr Ian Hosford (chair, PTAC, psychiatrist), Dr Jim Lello (PTAC, general practitioner) Dr Crawford Duncan (psychiatrist), Dr Jan Holmes (general practitioner), Dr Verity Humberstone (psychiatrist), Professor Richard Porter (psychiatrist), Professor John Werry (psychiatrist) Neurological - Dr Tom Thompson (chair, PTAC, physician), Dr Sisira Jayathissa (PTAC, physician), Dr Alistair Dunn (general practitioner), Dr Lindsay Haas (neurologist), Dr William Wallis (neurologist), Dr Peter Bergin (neurologist) Ophthalmology - Dr Tom Thompson (chair, PTAC, physician), Dr Neil Aburn (ophthalmologist), Dr Rose Dodd (general practitioner), Dr Steve Guest (vitreo retinal surgeon), Dr Allan Simpson (ophthalmologist) Respiratory - Dr Jim Lello (chair, PTAC, general practitioner), Professor Carl Burgess (PTAC chair, internal medicine physician), Dr John Kolbe (respiratory physician), Dr Ian Shaw (paediatrician), Dr John McLachlan (respiratory physician) Special Foods - Dr Jim Lello (chair, PTAC, general practitioner), Dr Simon Chin (paediatric gastroenterologist), Kerry McIlroy (dietician), Jo Stewart (dietician), Moira Styles (dietician), Dr John Wyeth (gastroenterologist) Tender Medical - Dr Paul Tomlinson (chair, PTAC, paediatrician), Dr Jim Lello (general practitioner), Dr Tom Thompson (physician), Ms Sarah Fitt (pharmacist), Dr Grant Howard (intensive care specialist), Geoff Savell (pharmacist), Clare Randall (Palliative Care Clinical Pharmacist), John Savory (pharmacist), Dr David Simpson (haematologist) Transplant Immunosuppressant – Dr Paul Tomlinson (Chair, PTAC, paediatrician), Dr Peter Pillans (physician/clinical pharmacologist), Dr Peter Ganly (haematologist), Dr Peter Ruygrok (cardiologist), Dr Richare Robson (nephrologist), Dr Kenneth Whyte (respiratory physician), Dr Stephen Munn (transplant surgeon)

Hospital Pharmaceuticals Advisory Committee (HPAC)

Ian Winwood (chair, clinical co-ordinator pharmacy services, Southland), Sarah Fitt (pharmacy manager, Auckland DHB), Neil Aitcheson (materials manager, MidCentral DHB), Paul Barrett (pharmacy services manager, Canterbury DHB), Jan Goddard (manager pharmacy services, Waikato DHB), Lesley Hawke (service manager - pharmacy, Counties Manukau DHB)

Panels

Exceptional Circumstances Panel Dr Howard Wilson (chair, general practitioner, pharmacologist), Dr Mel Brieseman (Medical Officer of Health, Christchurch) Dr Paul Tomlinson (paediatrician, Southland DHB), Dr David Waite (physician, Capital & Coast DHB), Dr Sharon Kletchko (manager funding & planning, Nelson Marlborough DHB), Dr Andrew Herbert (consultant gastroenterologist, MidCentral DHB) Cystic Fibrosis Advisory Panel Dr John Kolbe (respiratory physician), Dr Ian Shaw (paediatrician), Dr Richard Laing (respiratory physician), Dr Cass Byrnes (paediatrician) Gaucher Treatment Advisory Panel Dr Callum Wilson (metabolic consultant), Dr Ruth Spearing (consultant haematologist), Dr Clinton Pinto (musculoskeletal radiologist) Multiple Sclerosis Treatment Advisory Panel Dr Ernie Willoughby (neurologist), Dr David Abernethy (neurologist), Dr Alan Wright (neurologist)

PHARMAC’s Management Team

Chief Executive Matthew Brougham MSc (Hons), Dip Health Econ (Tromso) Management Team Peter Alsop - Manager, Corporate Steffan Crausaz BPharm, MSc, MRPharmS - Manager, Funding & Procurement Rachel Mackay BA, NZIMR - Manager, Schedule and Contracts Dr Peter Moodie BSc, MBChB, FRNZCGP - Medical Director Marama Parore (Ngati Whatua, Ngati Kahu, Nga Puhi) - Manager, Access and Optimal Use & Māori Health Manager Rico Schoeler - Manager, Analysis & Assessment

Consumer Advisory Committee (CAC)

Sandra Coney (chair, women’s health advocate, Auckland), Vicki Burnett (mental health consultant, Auckland), Sharron Cole (Patron, Parents’ Centres, Wellington), Matiu Dickson (Te Runanga o Kirikiriroa chair, Hamilton), Dennis Paget (Grey Power, Blenheim), Paul Stanley (general manager, Waipareira Trust), Kuresa Tiumalu-Faleseuga (social services consultant, Levin - resigned), Te Aniwa Tutara ( Māori health manager, Waitemata DHB), Heather Thomson (health manager, Te Aroha, Eastern Bay of Plenty)

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Pharmaceutical Management Agency Level 9, Cigna House, 40 Mercer Street, PO Box 10-254, Wellington 6143, New Zealand Phone: 64 4 460 4990 - Fax: 64 4 460 4995 - www.pharmac.govt.nz Freephone Information line (9am-5pm weekdays) 0800 66 00 50 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.