This is the text extract for 2012-02 Clinicians Newsletter, browse documents here.

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Pharmaceutical Management Agency

Clinicians’

“Make life easier, always think generically”

Newsletter

February 2012

Named Patient Pharmaceutical Assessment (NPPA)

From 1 March 2012, PHARMAC’s Named Patient Pharmaceutical Assessment (NPPA) will come into effect. This will replace the current Exceptional Circumstances schemes and includes changes like the removal of criteria restricting funding to rare conditions and changes to the application process, for example being able to apply electronically. For more information, including the NPPA Policy, criteria and contact details, visit our website at http://www.pharmac.govt.nz/ haveyoursay/ecreview.

This will give clinicians and patients time to make a change should patients wish to receive a fully funded product. These changes have previously been notified. Please refer to the full Notification located on the PHARMAC website for further details. http://www.pharmac.govt.nz/healthpros/notification

Insulin Glargine removal of prescriber note

In August 2010 the Special Authority restriction for insulin glargine (Lantus and Lantus SoloStar) was removed and replaced with a “prescriber note” (effectively a guideline). This prescriber note has now been removed from 1 February 2012. This means that there are no restrictions on this medicine.

Subsidy changes for some respiratory inhalation products and access restrictions to combination inhalers

Subsidy and restriction changes will occur to some respiratory inhalation products from 1 February 2012. These changes vary from that summarised in previous notifications. The changes are summarised below: Change of Access • Widening of access to combination inhalers by removing the requirement for patients to be on separate ICS and LABA inhalers for at least three months prior to being eligible for funded combination inhalers via Special Authority. This means that a patient who has trialled a minimum of three months ICS (with or without a LABA) may now go straight on to a combination inhaler (Symbicort or Seretide). Please note a Special Authority number is still required. Change to subsidies • From the 1st of February 2012 there will again be full funding for all patients for budesonide with eformoterol via Special Authority - all strengths of Vannair and Symbicort Turbuhaler. This applies to both new and existing patients. • From the 1st of February 2012 there will be surcharges for eformoterol inhalers (Oxis Turbuhaler and Foradil); however the chemical will remain fully funded when used as a combination product with budesonide (Symbicort and Vannair). Note that this surcharge does not apply to salmeterol (Serevent) which will remain fully funded on its own and in combination with fluticisone (Seretide). To assist the implementation of these changes Oxis Turbuhaler and Foradil repeat dispensings for prescriptions where the first dispensing was before 1 February 2012 will be fully funded. 05 Mar 2012 Red Rash Made Easy

Pharmaceutical Management Agency

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/ Date 20 Feb 2012 Topic Clinical Pharmacology for Nurses Description Nurses involved in patient medication management and those looking to update their knowledge and understanding on how drugs work. GP’s, Nurses, Pharmacists and other front line health professionals dealing with clinical patients This is a repeat seminar

29 Mar 2012

Assessing and Managing the Newborn Polypharmacy Care of the Older Person

18 May 2012

General practitioners, pharmacists and nurses working with patients on complex medication regimens.

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Pharmaceutical Management Agency - Clinicians’ Newsletter - February 2012

Brand Changes

Pharmacy Brand Switch Payment for Bicalutamide Brand switch payments for pharmacies will be payable for dispensings of the Bicalaccord brand of bicalutamide 50mg tablets from 1 February 2012. The brand switch fee is claimable via a Pharmacode on the first dispensing of bicalutamide after 1 February 2012 for patients who have switched brands. Pharmacies should claim a fee even if the patient switched to the Sole Supply brand prior to 1 February 2012. The brand switch fee for bicalutamide will be paid only once for each patient during the claim period. The brand switch fee will not be able to be claimed for this pharmaceutical for dispensing after 30 April 2012. Brand switch posters, leaflets and prescription bags are available free of charge. To order, please go to www.pharmaconline.co.nz Discontinuation of Cardinol 10mg and 40mg tablets

New Listings

New Listing Rizatriptan From 1 March 2012 a new brand of Rizatriptan orodispersible tablets will be listed on the Pharmaceutical Schedule. Rizamelt is to be supplied by Mylan New Zealand and will be awarded sole supply from 1 August 2012.

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 jessica@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

Mylan are discontinuing the supply of the Cardinol brand of propranolol 10mg and 40mg tablets. Current supplies are expected to last until February 2012 for 40mg tablets and until April 2012 for the 10mg tablets. Alternative Beta adrenoreceptor blockers are fully funded. The long-acting 160mg propranolol capsules (Cardinol) will continue to be supplied. Ethinyloestradiol 30 mcg with levonorgestrel 150 mcg tablets From 1 April 2012 a new brand of ethinyloestradiol 30 mcg with levonorgestrel 150 mcg and 7 inert tablets, Ava 30 ED, will be listed on the Pharmaceutical Schedule. This is the result of a tender agreement and from 1 June 2012 there may be a part charge on Levlen ED and Monofeme and an increase in the part charge currently applying to Nordette 28 and Microgynon 30 ED. Levlen ED, Monofeme, Nordette 28 and Microgynon 30 ED will be delisted from 1 September 2012. Calcium Carbonate 600mg tablets From 1 May 2012 only the 500mg strength of Calcium carbonate tablets will continue to be funded. This is the result of a tender agreement and at this time the Calci-tab brand of 500mg and 600mg tablets will be delisted.

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 February 2012, for the full reference; please consult your Update to the Pharmaceutical Schedule.