This is the text extract for 2011-07 Clinicians Newsletter, browse documents here.

---

Pharmaceutical Management Agency

Clinicians’

“Make life easier, always think generically”

Newsletter

July 2011

Changes to Schedule subscriptions

Later this year PHARMAC will be making subscription changes to the Pharmaceutical Schedule. These changes will mean that, if you want to continue to receive a printed copy of the Schedule, you will be charged for it. Online and email versions of the Schedule will continue to be provided free of charge and we will be improving the functionality of the online Schedule on the PHARMAC website. Hard copies will cost $55.00 per annum for the community Schedule. This fee does not represent full cost recovery, but a contribution towards the cost of printing and postage. We will shortly announce when the new fees will apply and how to activate your free e-mail subscription and/or the paid hard copy subscription. Subscriptions will be managed via a secure website, links to which will be via the PHARMAC website.

Pharmaceutical Management Agency

December 2010

New Zealand Pharmaceutical Schedule

Pharmaceutical Management Agency

April 2011

New Zealand Pharmaceutical Schedule

Pharmaceutical Management Agency

August 2010

New Zealand Pharmaceutical Schedule

New Listings

Dabigatran Dabigatran (Pradaxa) is a direct thrombin inhibitor and is an approved treatment for the indications of atrial fibrillation and venous thromboembolism (VTE) prophylaxis following major orthopaedic surgery. Over time, we expect dabigatran will largely replace warfarin as the treatment of choice for these uses.

Patients who should remain on warfarin are those with mechanical heart valves, severe valvular disease requiring anticoagulation, long term treatment for deep vein thrombosis and pulmonary embolism, or severe renal impairment (<30ml/min creatinine clearance). Dabigatran 75 mg, 110 mg and 150 mg capsules (Pradaxa) will be fully subsidised with no Special Authority restrictions from 1 July 2011. Pradaxa will initially be provided in a bottle presentation, which has a shelf-life of 30 days once opened, but we are working with the supplier to introduce a blister packaging. Best Practice Advocacy Centre (bpac) will be putting together a series of educational activities for clinicians including articles in the Best Practice Journal (BPJ). The first article was included in the June 2011 edition of BPJ and is available on their website. With the help of a group of clinicians, PHARMAC has also facilitated the development of hospital guidelines for the management of bleeding whilst on dabigatran and its management perioperatively. These guidelines are available on the PHARMAC website. For further information regarding treating patients on dabigatran, go to: www.pharmac.govt.nz/healthpros/MedicineInformation/ Dabigatran

Olanzapine depot injection Olanzapine depot injection will be funded for patients with schizophrenia who are non compliant with oral medications and who have been admitted to hospital or treated in respite care, or intensive outpatient or home-based treatment, for 30 days or more in the last 12 months. Injections of 210 mg, 300 mg and 405 mg will be funded subject to Special Authority restrictions from 1 July 2011.

Patients should be monitored for post-injection syndrome for at least three hours after each injection.

Osteoporosis treatments – two new listings and amendment to restrictions Raloxifene (Evista) will be funded for patients with osteoporosis subject to Special Authority restrictions similar to those that currently apply to alendronate and zoledronic acid from 1 July 2011. Changes have also been made to the Special Authority criteria for alendronate and zoledronic acid to ensure that patients who receive an approval for raloxifene will be able to access alendronate and zoledronic acid. Raloxifene comes in 60 mg tablets.

Also from 1 July 2011, teriparatide (Forteo) injection 250 μg per ml, 2.4 ml, will be funded subject to Special Authority restrictions as a last-line treatment for osteoporosis.

---

Pharmaceutical Management Agency - Clinicians’ Newsletter - July 2011

Widening of Access

Fluconazole 150 mg capsules From 1 June 2011 fluconazole 150 mg capsules were taken off specialist restriction. Any practitioner from 1 June 2011 has been able to prescribe one fluconazole 150 mg capsule for patients with vaginal candida albicans; however, the prescription needs to be endorsed.

Fluconazole 150 mg capsules will not be funded in amounts greater than one capsule per prescription, even if prescribed by or on the recommendation of a specialist. For prescriptions greater than one day (written by or on the recommendation of a specialist) the 50mg capsule must be dispensed. If the dose is written using the 150mg capsule pharmacists are able to change the dispensing to the 50 mg capsules. The prescriber does not need to be contacted as it is not a change in dose and there is no extra cost to the DHB.

Fully funded alternatives include: > Budesonide with eformoterol MDI (Vannair)

> Fluticasone with salmeterol Accuhaler and MDI (Seretide) > Salmeterol Accuhaler and MDI (Serevent) > Eformoterol fumarate (Foradil)

Other Changes

Varenicline (Champix) – clarification of funded treatment length Amendments have been made to the Special Authority criteria for varenicline tartrate (Champix) tablets to make it clear that a maximum of 3 months’ varenicline will be subsidised on each Special Authority approval. This was the original intent of the 3-month Special Authority approval period but it was not previously explicitly stated on the application form.

We recommend that patients are prescribed one starter pack and the remainder of the 12-week treatment course on the same prescription to avoid potential confusion. In other words, the prescription should include one starter pack (two weeks’ treatment) plus 10-weeks of continuance treatment. If separate prescriptions are written for the starter pack and continuance treatment, only 10 weeks of the continuance treatment will be subsidised. We also recommend that patients are made aware they will get only one subsidised 12-week treatment course in a year.

Nicotine Replacement Therapy (NRT) – addition to Practitioners Supply Order (PSO) list All strengths and flavours (where relevant) of nicotine patches, lozenges and gum will be available on a PSO from 1 July 2011. Note that the PSO may only be used to ensure medical supplies for emergency use, teaching and demonstration purposes, and for the provision to certain patient groups where individual prescription is not practicable. We expect the main use of NRT obtained on a PSO would be for teaching and demonstration purposes. Patients will still need to obtain prescriptions or Quit Cards for funded NRT.

Restriction of access to Symbicort and Oxis

Symbicort Turbuhaler and Oxis Turbuhaler– changes to subsidy for new patients From 1 July 2011, a part charge will apply to all new patients prescribed budesonide with eformoterol powder for inhalation (Symbicort Turbuhaler), and eformoterol fumarate powder for inhalation 6µg (Oxis Turbuhaler). Existing patients will continue to be fully funded with endorsement.

Patients who have been prescribed Symbicort or Oxis before the 1st July 2011 will be able to continue with full subsidy provided they have a valid special authority AND the script is endorsed with the information that they started or were prescribed the drug(s) before that date. If you forget to do this the pharmacist may add this endorsement providing they have documented evidence on their systems that they qualify. This will unfortunately need to be in place for a few months while we decide on the options for ongoing management of subsidies for these pharmaceuticals. Please let your existing Symbicort and Oxis patients know that they do not need to pay anything extra for their medicines. Some pharmacies will need to manually override their systems to enable the full subsidy to apply and if that does not occur, your patient maybe be inadvertently charged a part charge.

Special Foods - Substitution Clarification and Stock Report Ensure powder vanilla, both 400 g and 900 g tins have arrived and we have confirmation there is sufficient stock at wholesalers. Ensure powder chocolate 900 g is due to arrive on July 17 2011 and back orders will be filled shortly after this date.

Sustagen Hospital Formula vanilla and chocolate both remain in stock and we do not anticipate any stock issues.

Item of Interest

Docetaxel – Removal of Special Authority From 1 July 2011 the Special Authority criteria applying to the funding of docetaxel will be removed. Docetaxel will remain listed as “PCT only – Specialist” pharmaceutical meaning it is only subsidised when claimed for by DHB Hospitals as a treatment for cancer.

---

Pharmaceutical Management Agency - Clinicians’ Newsletter - July 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) Topic

Update on Prescribing and Using Standing Orders in Schools

Pharmaceutical Management Agency

Description

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.

29 July

5 August

Rest Home Prescribing

22 August

Common Paediatric Conditions (repeat)

ISSN 2230-4703 (Print)

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.

ISSN 2230-4711 (Online) Special Authority Queries: 0800 243 666 General Questions: 0800 66 00 50 (9am – 5pm Monday to Friday) Online version of Prescriber newsletter: http://www.pharmac.govt.nz/healthpros/CliniciansNews Inpharmation newsletter: http://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 July 2011, for the full reference; please consult your Update to the Pharmaceutical Schedule.

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)

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.