This is the text extract for 2011-06 Clinicians Newsletter, browse documents here.

---

Pharmaceutical Management Agency

“Make life easier, always think generically”

GP Newsletter

June 2011

Proposal for six monthly prescriptions

- Medicines Regulations Changes MedSafe is proposing to extend the length of a prescription from three months to six months. MedSafe has advised PHARMAC that the proposed changes to the Medicines Regulations described in the March edition of MedSafe’s Prescriber Update are not yet in force. The Ministry of Health will inform healthcare professionals of the date the changes will come into force. Further information about the proposed changes to the Medicines Regulations is available from MedSafe at: http://www.medsafe.govt.nz/profs/PUArticles/ ChangestoMedicinesRegulations.htm

Removal of Restrictions

Olanzapine – new listings Two new brands of olanzapine tablets and orodispersible tablets will be listed without restriction and fully subsidised from 1 June 2011, Dr Reddy’s Olanzapine and Olanzine tablets 2.5 mg, 5 mg and 10 mg, and Dr Reddy’s Olanzapine and Olanzine-D orodispersible tablets 5 mg and 10 mg.

The Zyprexa and Zyprexa Zydis brands will continue to be listed in Section B of the Pharmaceutical Schedule subject to their current Special Authority restrictions until 1 September 2011 when their subsidy will be reduced to the level of the generic brands and the Special Authorities will be removed. This means that there will be no restriction on who can initiate and prescribe olanzapine provided that the script is written using the generic name.

Special Foods – Update

From 1 April 2011 a number of changes were made to the funding and access to Special Foods including: • vocationally registered General Practitioners being able to initiate Special Authorities • reduced subsidy for the standard ready-made liquid supplement feeds (Fortisip, Ensure Plus, Fortisip Multi Fibre and Two Cal HN) except for patients being bolus fed through a feeding tube who can gain full funding when the prescription is endorsed - Ensure powder and Sustagen Hospital Formula powder remain available fully funded • changes to the Special Authority criteria for the standard supplements (liquids and powder) and specialised infant formula (Pepti Junior Gold, Elecare and Neocate ranges). There are some technical difficulties with on-line Special Authority applications for standard supplements. These issues are being worked through. Should you not be able to do an electronic application then a manual application can be filed. The patient information leaflet explaining the changes to the funding of nutritional products is available to order in hard copy from bpacnz. http://www.bpac.org.nz/resources/orders/admin/ resource_order.asp A link to the order form is also available on the PHARMAC website. There is no restriction on how many information leaflets you can order. http://www.pharmac.govt.nz/patients/ SpecialFoodsChanges. A special edition of the Best Practice Journal has also been developed and distributed to health professionals about the appropriate use of Special Foods. This can be accessed from the bpacnz website, www.bpac.org.nz. A televised medical CME session was held on 5th May – for those people who missed this, it can be viewed here: http://www.bpac.org.nz/magazine/2011/ specialfoods/videoLinks.asp

Sumatriptan injection – removal of Specialist restriction The “Retail pharmacy-Specialist” restriction that currently applies to sumatriptan injection will be removed from 1 June 2011. The “Maximum of 10 injections per prescription” restriction will remain.

This means that there will be no restriction on who can initiate and prescribe sumatriptan injection provided that the script is written using the generic name.

Fluconazole – removal of Specialist restriction A Specialist recommendation will no longer be required by prescribers for fluconazole 150 mg capsules from 1 June 2011, but will be replaced by an endorsement requirement. The endorsement must state that it is for patients with vaginal candida albicans and must be endorsed by the prescriber. Only one capsule will be subsidised per prescription. The Retail pharmacy-Specialist restriction will remain on fluconazole 50 mg and 200 mg capsules.

Ondansetron – widened access From 1 May 2011 the prescribing and dispensing restrictions that currently apply to ondansetron tablets and dispersible tablets will be removed. This means that there will be no restriction on the number of tablets subsidised per prescription or dispensing, regardless of indication, and no restriction on who can initiate and prescribe ondansetron provided that the script is written using the generic name Influenza vaccine – access widened for Canterbury DHB The access criteria for funded influenza vaccine has widened. Subsidy is now available for people under 18 years of age living within the boundaries of the Canterbury District Health Board.

---

Pharmaceutical Management Agency - GP Newsletter - June 2011

Other Changes

Morphine sulphate long-acting tablets – brand change A new brand of morphine sulphate long-acting tablets, ArrowMorphine LA has been awarded the Sole Subsidised Supply tender for both the community and hospitals markets until 30 June 2013. The current subsidy for LA-Morph by Douglas Pharmaceuticals will be discontinued from 31 October 2011. Arrow-Morphine LA is supplied in blisters rather than bottles. Zapril now available in bottles The Zapril brand of cilazapril 2.5 mg and 5 mg tablets will be supplied, and subsidised, in bottles rather than blister packs from 1 June 2011. The change from blister packs to bottles is because the tablets sometimes broke when removing them from the blister packs. Zapril 0.5 mg tablets remain unchanged as it was already supplied in a bottle. Ornidazole – new listing The current brand of ornidazole (Tiberal) has been discontinued by Roche Products (NZ) Limited and current supplies of Tiberal are low. The Arrow brand of ornidazole 500 mg tablets, Arrow-Ornidazole, will be subsidised from 1 June 2011, however Arrow-Ornidazole will not be available until 13 June 2011. New funded treatment for epilepsy Lacosamide (Vimpat) tablets became funded as a last-line treatment for epilepsy from 1 May 2011. Funding is subject to Special Authority criteria for patients with partial-onset epilepsy and seizures which are not adequately controlled by, or the patient has experienced unacceptable side effects from, optimal treatment with other epilepsy treatments. New funded treatment for narcolepsy Modavigil (modafinil) 100 mg tablets is now funded for the treatment of narcolepsy. Funding is available via Special Authority approval for the treatment of hypersomnia associated with narcolepsy in patients who cannot tolerate methylphenidate or dexamphetamine, or in whom both methylphenidate and dexamphetamine are contraindicated.

Item of Interest

- New treatment options for patients with multiple myeloma and amyloidosis Bortezomib (Velcade) 3.5 mg injection and 1 mg for ECP is funded for patients with treatment naïve and relapsed/refractory multiple myeloma and systemic AL amyloidosis (i.e. first and second line treatment).

A new strength of thalidomide, 100 mg capsule, is also subsidised. The “Pharmaceutical Cancer Treatment – Only” (PCT-only – Specialist) restriction remains on all strengths and brands of thalidomide. Funded access to thalidomide has also been widened to include funding for all patients with multiple myeloma and systemic AL amyloidosis through an agreement with Celgene Pty Limited.

Exceptional Circumstances Review

PHARMAC has undertaken a Review of the Exceptional Circumstances (EC) schemes. We sought feedback from a broad range of stakeholders on a discussion document “Review of Exceptional Circumstances: Seeking Your Views” which was released in August 2010 (www.pharmac.govt.nz/2010/08/02/EC%20doc%201.pdf ). The document included key questions about the purpose, criteria, funding and operations of Exceptional Circumstances. The review of EC aims to: • review and clarify the purpose of the provision of funding in exceptional circumstances, • review and clearly describe what constitutes ‘exceptional circumstances’, and • ensure the funding and operational arrangements for exceptional circumstances are optimal. We received 76 written submissions from a wide variety of stakeholder groups. The responses and other feedback received have informed the development of proposals which we consulted on in a second document “Review of Exceptional Circumstances: Consultation on Proposed Changes” which was released in January 2011 (www.pharmac.govt.nz/2011/01/10/EC%20consult.pdf ). We have recently closed consultation on the proposed changes and are considering all feedback we received. We are currently considering what changes, if any, to make to the EC scheme. We intend to provide a proposal to the PHARMAC Board in June. Although the consultation period on proposed changes to EC is closed, you can still read the consultation document, PHARMAC’s Review of Exceptional Circumstances: Consultation on Proposed Changes www.pharmac.govt.nz/2011/01/10/EC%20consult.pdf For further information, or if you have any questions about this review please contact: Bryce Wigodsky PHARMAC, PO Box 10-254, Wellington 6143 Email: ecreview@pharmac.govt.nz Telephone: (04) 460 4990 Fax: (04) 460 4995

---

Pharmaceutical Management Agency - GP Newsletter - June 2011

PHARMAC Seminar Series – Upcoming Seminars

The PHARMAC Seminar Series provides high quality educational seminars for a range of health professionals. The seminars are held in Wellington and the cost to attend is $100 + GST. PHARMAC covers the cost of travel, including flights, to and from the seminar and provides catering on the day. For further information on the seminars below, and to register for a place, head to our website: www.seminarseries.pharmac.govt.nz Dates (2011)

16 June

Topic

Communication Workshop Polypharmacy Care of the Older Person Controversies in Screening: What is the Evidence? Update on Prescribing and Using Standing Orders in Schools

Description

Covers concepts of resilience and stress-vulnerability, and looks at a broad range of potential interventions which can address stress-induced anxiety and depression When the patient has multiple comorbidities and they simply don’t fit the guidelines. Covers tools and structure for the medicine rationalisation process. Reviews the basic concepts which underpin screening such as prevalence, sensitivity, specificity, etc, and use those features to analyse screening programs in current use. Evaluates more controversial screening strategies such as PSA tests and bowel cancer screening. Focuses on standing orders for school based health services through links with primary health care and why they can make a difference. Updates on youth health issues, relevant pharmacology, understanding the legislation that supports safe practice, presentations from GPs and school nurses who currently use standing orders, and workshop on developing standing orders. Covers some of those areas that are chronically undertreated in the elderly and some of those areas in which treatment is often confused. There will be a focus on how to manage some of those acute management issues in the rest home environment; and we’ll spend some time looking at the end of life/palliative care perspective of residential care. Focuses on common conditions in childhood that present to the general practice. Areas covered will include chronic cough, constipation, dental problems, the six-week check, changes to the immunisation schedule, head shapes and fontanelles, rashes and behavioural and learning issues.

17 June

11 July

29 July

5 August

Rest Home Prescribing

22 August

Common Paediatric Conditions (repeat)

Pharmaceutical Management Agency

What’s cooking in Prescription Kitchen?

PHARMAC has been involved in a new and innovative way to deliver medical education to clinicians. Prescription Kitchen, the first in a series called HealthQ, was a collaboration between PHARMAC, BPACnz and Mobile Surgical Services that provided an innovative way to deliver continuing medical education (CME) to health professionals. As part of this, a live and interactive CME session was held on Thursday 5 May and screened on Sky TV.

Special Authority vigilance

Special Authority is the mechanism PHARMAC uses to target medicines to people who need them most. The system is only as good as our ability to ensure it is used properly, so we routinely commission audits to check the system is being used as intended. During the course of an audit into the Special Access process (which is similar to the Special Authority process) for the ADHD drug Ritalin SR, we became aware of some irregularities around some doctors’ use of the forms. Having identified particular concerns in relation to two doctors, we made a complaint to the Medical Council, whose Professional Conduct Committee decided to lay charges against the doctors before the Health Practitioners’ Disciplinary Tribunal. The charge against one of the doctors was withdrawn after he acknowledged that he had completed some of the criteria in the special access forms in error in the context of a busy practice. The charges against another doctor, Dr John Anthony Hanne of Auckland, proceeded to a tribunal hearing. During the course of the hearing the tribunal agreed to the withdrawal of the charges after Dr Hanne agreed to make a statement accepting that his actions fell below the standards of optimal practice, that he regretted the errors, and that he will take more care with completing forms in future. The full decision can be found at http://www.hpdt.org.nz/Default. aspx?tabid=293. PHARMAC will continue to commission regular audits of Special Authority Processes.

MAY 2011

Let the facts speak for themselves?

When we live in a world where evidence is meant to trump opinion, you’d think facts were all that’s needed to convince others of the strength of an argument. But facts can be mistakenly connected to other facts, leading to incorrect interpretations. We’ve seen a bit of this around the topic of PHARMAC lately. Take this statement for example: “New Zealand’s per capita spending on pharmaceuticals is below the OECD average.” The statement is undeniably true. But what does it mean, and is it good or bad? If you are a pharmaceutical lobby group calling for more funding for medicines, the meaning put around this fact is a claim that spending more on medicines leads to better health outcomes (despite the report citied1 showing the United States, which has the highest prices and highest per capita spend on pharmaceuticals, also has the highest mortality from preventable diseases). From PHARMAC’s point of view, the fact that we spend less per capita on pharmaceuticals is pretty good. Because New Zealand’s population health outcomes are broadly in line with OECD averages, the fact illustrates the value for money PHARMAC achieves for our medicine funding system. Here’s another fact: “New Zealand’s mortality from preventable diseases has been improving faster than the OECD average.” We think this fact is a good thing. It also comes from the same report the industry

1

>> • Patients with severe genetic diseases (inborn errors of metabolism) will have easier access than before. • Children who need specialised infant formulae will need to follow international guidelines – these require people to try simpler and cheaper formulae before more complex and expensive formulae. We have received the most feedback from people about changes to adult sip feeds. They come in two types – ready-made liquid preparations and powdered versions that need to be mixed with water. The ready-made versions have been more expensive for PHARMAC to fund. We’ve had advice that the powdered and ready-mixed versions of these products are pretty much the same, so we think it’s reasonable to pay the same subsidy for both. Powdered drinks will be fully subsidised, and people can choose to pay the difference if they opt for the ready-made liquid products. In making the funding changes, we’ve thought about people with particular needs like those who are tube fed and rely on liquid feeds for their full nutrition (known as enteral feeds). We’ve created rules so that tube-fed patients can have ready-mixed enteral feed preparations fully funded and not have to pay a part-charge. We’ve also worked to ensure that access to funded Special Foods is appropriately targeted so that the people who are in genuine clinical need receive funded products. Full details and patient information about the changes are available at http://www.pharmac.govt.nz/patients/SpecialFoodsChanges

Te Matatini and Whˉ nau Hauora Village a

This first session focused on the current Pharmaceutical Schedule changes to Special Foods, and supplemented the other medical education that is occurring. The Sky TV session, compered by veteran A PHARMAC-led initiative was a major drawcard broadcaster Ian Fraser, involved live panel discussion with expert at the Te Matatini o te clinicians as Rā national kapa haka festival in Gisborne on 16-20 February.well as pre-recorded video clips and opinion pieces in order to provide as dynamic an approach to CME as possible. PHARMAC worked with a range of groups including Tairawhiti District There was also the Health Board, Plunket, National Heart Foundation, Te Hotu Manawa opportunity for health professionals to text or email questions they Māori, Quit Group, Māori Pharmacists Association, Turanganui a Kiwa had for the panel both in advance of the show, health and Midlands Health Network to create a as well asHauora its screening. Health professionals, including GPs, Whānau during paediatricians, geriatricians and dietitians were sent an ‘invite’ to tune Village for the duration of the festival. in to the screening. Services offered included men’s heart health checks, diabetes We will be monitoring the response to Prescription Kitchen. Should screening, well child checks, cancer services including cervical this first session screening, nutrition and physical activity guidance and smoking be successful, a further two Sky TV based sessions may cessation advice and support. Specialist services be developed for other medical subject matter during 2011. included sexual health and oncology (cancer) expertise, medications advice and counselling, all provided by senior Māori clinicians. The village concept was extremely popular, with 2,500 people visiting the Village (out of approximately 50,000 people attending the festival). PHARMAC and the festival organisers put a lot of effort into creating an environment where people felt safe and welcomed and were willing to take part in the various services on offer. This meant that, despite being set up in little more than a tent in a field, highly professional services were offered in a setting that made people feel at ease and well cared for. Services provided during the festival included: • 303 men had their heart and diabetes status checked (of these, 145 were considered high risk – greater than 15% chance of a heart event)

ISSN 2230-4703 (Print) ISSN 2230-4711 (Online) Special Authority Queries: 0800 243 666 General Questions: 0800 66 00 50 (9am – 5pm Monday to Friday) Online: www.pharmac.govt.nz/healthpros/Schedule/PHONewsletter Inpharmation newsletter: www.pharmac.govt.nz/patients/ourviews/inpharmation Newsletter feedback: email susan.haniel@pharmac.govt.nz Please note this is not a complete reference to all changes occurring from 1 June 2011, for the full reference; please consult your Update to the Pharmaceutical Schedule.

FORUM

– save this date

The PHARMAC Forum is coming – make a note of this date: 17 February 2012. The Forum has become an important part of PHARMAC’s business and getting stakeholder input to our work. For the next Forum, we’re looking at additional opportunities for getting input from consumers and front line health professionals, in particular pharmacists and General Practitioners. We plan on holding regional ‘mini-Forums’ later in 2011, which will give people a further opportunity to contribute to the discussion around Forum topics. We’ll provide more information, including dates, about these mini-Forums in the near future.

has been using to promote its case that it is a bad thing that New Zealand spends less on pharmaceuticals. Unfortunately such recent comments haven’t had a lot of factual backing. Rather, these arguments need to be unpicked and corrected, something that is readily done using documents easily obtained through our website or from other sources. And that’s a fact.

• 200 women had diabetes checks • 20 women had cervical smears

“A MAN WITH A CONVICTION is a hard man to change. Tell him you disagree and he turns away. Show him facts or figures and he questions your sources. Appeal to logic and he fails to see your point.” -Leon Festinger

• 200 contacts were made with families with young children The Village concept emphasised the idea that healthcare is a concern for families as a whole, not just for individuals. Many of the people seen at the Village did not have regular contact with health professionals. Two of the women who had cervical smear tests had never had one before. ISSN 1179-7401

Measuring The Health Of Nations: Updating An Earlier Analysis Ellen Nolte and C. Martin McKee Health Affairs, 27, no. 1 (2008): 58-71 doi: 10.1377/hlthaff.27.1.58

PHARMAC and its partners in the Whānau Hauora Village feltthe Government agency responsible for deciding which medicines are subsidised for New Zealanders. PHARMAC is the It manages spending concept, bringing together a range of services working together on pharmaceuticals for the District Health Boards, and ensures that a comprehensive list of medicines (the Pharmaceutical Schedule) is subsidised for New under one roof, worked extremely well. The concept of a health Zealanders. village is an exercise they are keen to repeat at future festivals and Level 9, 40 Mercer Street, PO Box 10-254, Wellington 6143, New Zealand Contact: PHARMAC, the Whānau Hauora Village has been invited back to be part of the Te Phone: +64 (0)4 460 4990 - Fax: +64 (0)4 460 4995 - www.pharmac.govt.nz Matatini festival in 2013.

inPharmation

PHARMAC publishes a quarterly email newsletter, inPharmation, that includes news and updates on developments around PHARMAC and pharmaceutical issues. If you would like to receive inPharmation, contact simon.england@pharmac.govt.nz.