This is the text extract for 2011-12 Clinicians Newsletter, browse documents here.

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Pharmaceutical Management Agency

Clinicians’

“Make life easier, always think generically”

Newsletter

December 2011

Want to join a PHARMAC Subcommittee?

We are interested in hearing from general practitioners who would be interested in joining one of our Pharmacology and Therapeutics Advisory Committee (PTAC) subcommittees. If you would like more information please contact the PTAC Secretary Rochelle Harker on rochelle.harker@pharmac.govt.nz

Widening of Access

Fluconazole 150 mg capsule – restriction amended From 1 December the restriction on Fluconazole 150 mg capsules will be amended. The original restriction for Practitioners will remain the same, however the maximum of one capsule per prescription may now be waived by a Specialist endorsement or on the recommendation of a Specialist. Losartan – removal of Special Authority The Special Authority has been removed from losartan tablets 12.5 mg, 25 mg, 50 mg, 100 mg and tablets 50 mg with hydrochlorothiazide 12.5 mg from 1 December. The funded brand of losartan only tablets is Lostaar (Mylan’s brand) and the combined losartan 50 mg with hydrochlorothiazide 12.5 mg tablets is Arrow-Losartan & Hydrochlorothiazide (Arrow Pharmaceuticals).

Note this does NOT apply to candesarten which remains on Special Authority.

Enoxaparin sodium – Special Authority change The Special Authority criteria for enoxaparin sodium (Clexane) injection will be amended from 1 December 2011. The change will allow patients on any oral anticoagulation, either warfarin or dabigatran, to gain a subsidy via Special Authority for venous thromboembolism other than in pregnancy or malignancy perioperatively. Solu Medrol – new pack sizes Pzifer has notified PHARMAC of a global change of formulation to three presentations of Solu Medrol injection 40 mg per ml, 1 ml, injection 62.5 mg per ml, 2 ml and injection 500 mg. The new formulations have a preservative-free diluent (without benzyl alcohol) and Pfizer has prepared information for the market. There has also been a pack size change from a 25 injection pack to a single injection pack for both the injection 40 mg per ml, 1 ml and 62.5 mg per ml, 2 ml.

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Pharmaceutical Management Agency - Clinicians’ Newsletter - December 2011

Spacer Devices

Masks for Spacer Devices There has been a brand name change for masks for spacer devices. Foremount Child’s Silicone Mask will be listed as EZ-fit Paediatric Mask from 1 December 2011. This is a brand name change only. Spacer Devices: 230 ml Spacer Device A new single patient spacer device, Space Chamber Plus, will be available fully funded from 1 December 2011. Space Chamber Plus has improved drug delivery compared to the currently funded Space Chamber with an increase of ~80% in the weight of drug exiting the device. When switching, patients should be informed that they may experience a change in the effect and if they have any concerns they should contact their Doctor. Patients should also be monitored one month after making the change for the emergence of symptoms of disease or adverse effects. (This is particularly the case for paediatric patients). There has been no change to the PSO restrictions for this device. 800 ml Spacer Device There has been no change to this spacer device. Autoclavable 230 ml Spacer Device The number of autoclavable spacer devices available on a PSO has been reduced from 20 to 5. These spacer devices are intended for training purposes where they may be autoclaved between patients and used over and over again. Many people are unaware that there are autoclavable and single user spacers. The autoclavable devices are very useful for practice use but they are significantly more expensive and should not be used given to patients.

COMING SOON - Changes to PHARMAC Exceptional Circumstances Scheme

Do you apply for treatments for your patients under PHARMAC’s Exceptional Circumstances schemes? Or have you ever considered applying?

If so, you’ll need to know about the changes being made to these schemes. From 1 March 2012, PHARMAC’s Exceptional Circumstances schemes will be replaced with Named Patient Pharmaceutical Assessment (NPPA). These changes may help you to provide treatments to your patients that you previously weren’t able to. Highlights include: > removal of the criteria restricting funding to patients in a patient population of 10 or fewer > a new pathway for consideration of applications in urgent circumstances > a streamlined application process, including the ability to apply electronically > cancer and community treatments being considered under the same scheme, leading to more nationally consistent decisions > PHARMAC being able to fund some medicines through NPPA while they are under consideration for Schedule listing > a closer alignment of NPPA and full Pharmaceutical Schedule assessments, benefiting patient populations over time > PHARMAC publishing the outcome of funding applications, resulting in greater clarity and enhanced transparency for clinicians of what might be funded For more information, including the NPPA Policy, criteria and contact details, visit our website at: http://www.pharmac.govt.nz/haveyoursay/ecreview

New Listings

Amlodipine A new low strength of amlodipine will be fully funded from 1 December 2011. Amlodipine 2.5 mg will be supplied by Apotex under the name Apo-Amlodipine.

Changes to Schedule Rules

From 1 December the final changes to the Pharmaceutical Schedule General Rules, due to the enactment of the Medicines Amendment Regulations 2011, will come into effect. The last two changes affecting dentists and midwives, in summary, mean that dentists can now prescribe within their scope of practice up to three months’ supply for a patient under their care and midwives can now, for oral contraceptives, prescribe up to six months supply.

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Pharmaceutical Management Agency - Clinicians’ Newsletter - December 2011

Pharmaceutical Management Agency

PHARMAC Seminar Series 2012

PHARMAC Seminar Series will be continuing in 2012. Topics and dates to be confirmed shortly see the website below for further details. 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. http://seminarseries.pharmac.govt.nz/

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

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

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>> • 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.

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 version of Prescriber newsletter: http://www.pharmac.govt.nz/healthpros/CliniciansNews Inpharmation newsletter: http://www.pharmac.govt.nz/patients/ourviews/inpharmation. Newsletter feedback: email rochelle.harker@pharmac.govt.nz Please note this is not a complete reference to all changes occurring from 1 December 2011, for the full reference; please consult your Update to the Pharmaceutical Schedule.