This is the text extract for 2012-07 Clinicians Newsletter , browse documents here.

---

Pharmaceutical Management Agency

Clinicians’

“Make life easier, always think generically”

Newsletter

July 2012

Vaccines

From 1 July 2012, PHARMAC formally took over the funding of vaccines and these have been listed on the Pharmaceutical Schedule. Practices and vaccinators will continue to have supplies free of charge. The day to day Immunisation Programme will continue to be managed by the Ministry of Health, and ESR will continue to manage the distribution of vaccines. There will be no change to the current payment mechanisms around the Immunisation Benefit. Although there are no plans to change what vaccinations are on the Schedule, PHARMAC will be responsible for considering any changes to the range of funded vaccines, including the eligibility criteria and funding of new vaccines.

Why has there been a change to the pharmacy contract? Up until now Pharmacies have been paid according to the number of scripts they dispense (volume) and the frequency of those dispensings. This has meant that there has been an incentive for some pharmacies to encourage clinicians to stipulate “Close Control” on their scripts. There has been some $82 million on Close Control ($42 million on weekly Close Control out of a total dispensing budget of $320 million). The new pharmacy services agreement removes the volume/ frequency based incentives and instead rewards patient based clinical care, where highly trained health professionals like pharmacists should be. How will it affect me as a prescriber? • Firstly the term “Close Control” has disappeared and will be replaced by the term “Dispensing Frequency” and for the most part this will be determined by the pharmacist. • When you repeat a script (or write a new one) ensure that you simply specify the quantity (90) or the period (3/12) and let the pharmacist sort out the detail. • In rare circumstances you might want to actively determine that frequency and if you do you need to make it clear on the script that that is exactly what you want. The pharmacist may contact you if they have a different view. • The prescribing rules in rest homes have not changed at all. • The pharmacy services agreement does not involve any payments to you, only the pharmacist. • The Medtech software currently allows you to prescribe a new medicine with an initial “trial” period. This system will not change. How will it affect my patients? • Some patients will be identified as having a “long term condition” (LTC) and likely to benefit from close watching by the pharmacist. The aim is to ensure that these patients both understand the purpose of their medicines and assist with compliance. You can determine who these patients are, or the pharmacist can make the call. Once they are identified or referred, the pharmacist will assess them against the entry criteria for the service. • In the meantime, the patients who are currently on Close Control will be maintained on their current dispensing frequency until they are assessed to see if they are eligible for the LTC service. Pharmacists have until 31 January 2013 to assess the current Close Control patients. • Another group of patients will be identified as taking medicines that have a safety issue (tricyclic and sedatives for example). Codeine and buprenorphine with naloxone have been added >>

Changes to Close Control rules & the new Pharmacy Agreement

Background Last month we signalled that there were to be changes to the “Close Control” rules and that, by and large, they should have little effect on your day to day working. These changes are part of the new pharmacy services agreement that started on the 1st July.

---

Pharmaceutical Management Agency - Clinicians’ Newsletter - July 2012

to the safety medicines list. The dispensing frequency for these patients will be determined by the Pharmaceutical Schedule rules or by you if you think the patient needs more frequent dispensing; however if the pharmacist wishes to make changes to the dispensing frequency they must contact you. • Finally there are the vast majority of patients who need no particular dispensing control and will be dispensed as per the Pharmaceutical Schedule rules. What should I do? • From a pharmacist perspective the rules are quite detailed but from your side of the fence you need to do very little EXCEPT avoid trying to write ‘Close Control type’ instructions UNLESS you really mean it! • Start talking to your local pharmacy, they are going to want to work with you with a number of your patients. Coordination of care is good for everyone. More information? Talk to you pharmacist, go to our website to see the technical details or you can call us on 0800 660050. Further information and resources can be found on our website www.pharmac.govt.nz/ccc

New Listings

Buprenorphine with naloxone (Suboxone) new listing From 1 July 2012, buprenorphine with naloxone sublingual tablets, Suboxone, will be listed fully subsidised subject to Special Authority criteria for detoxification and maintenance of treatment of opioid dependence. It is anticipated that this will have a real impact on methadone usage. Buprenorphine with naloxone (Suboxone) sublingual tablets are prescribed on a standard prescription form, not on a controlled drug.

New brands or brand changes

New low dose combined oral contraceptive brand – Ava 20 ED A new fully funded oral contraceptive with a low dose ethinyloestradiol 20 µg with levonorgestrel 100 µg tablets listed on the Pharmaceutical Schedule. Ava 20 ED (ethinyloestradiol 20 µg ethinyloestradiol with 100 µg levonorgestrel and 7 inert tablets), supplied by Arrow Pharmaceuticals, will be listed fully subsidised from 1 July. Sole Supply reinstated for amoxycillin clavulanate (Curam Duo) From 1 December 2012, Curam Duo will become the sole subsidised brand of amoxicillin clavulanate tablets. The listing of Curam Duo was delayed due to the supplier, Sandoz, being unable to supply at the time. Sandoz began supplying Curam Duo from March 2012. Synermox will be delisted 1 December 2012. New brand of atorvastatin (Zarator) Pfizer’s new brand of atorvastatin tablets, Zarator, will be listed fully subsidised from 1 August 2012. Zarator has been awarded sole subsidised supply from 1 January 2013 Macrogol 3350 powder – delay in brand change There has been a further delay in the listing of Lax-Sachets brand of macrogol 3350 powder supplied by AFT Pharmaceuticals. This product will now be listed from 1 August 2012, the Movicol brand will now be referenced price from 1 October 2012 and Lax-Sachets will commence sole supply on 1 January 2013.

Pharmaceutical Schedule subscription reminder

As mentioned in last months edition from 1 July 2012 there will be a chance to receive hard copy publications of the schedule. Please visit the subscription website for full information www.schedule.co.nz. You may choose to receive a free email reminder each month and this will link you to a downloadable PDF version of the Schedule. This can also be arranged via the subscription website.

Delistings / Discontinuations

The Regitine brand of phentolamine mesylate injection 10 mg per ml will be delisted from 1 January 2013 due to supplier discontinuation. From 1 January 2013, the Zerit brand of stavudine (D4T) 30 mg capsules will be delisted due to supplier discontinuation. The 40 mg presentation will remain subsdised. The Apo-Bromocriptine brand of bromocriptine supplied by Apotex will be delisted from 1 January 2013 due to supplier discontinuation. The 2.5 mg capsules will remain listed.

---

Pharmaceutical Management Agency - Clinicians’ Newsletter - July 2012

Subsidy or Special Authority Changes

Premature birth formula - Special Authority change The Special Authority criteria that currently applies to Premature Birth Formula (SA1109), brand name S26LBW Gold RTF, has been amended so that no new approvals will be given for this product. Patients with a current Special Authority approval will continue to be able to access a subsidy for S26LBW Gold RTF and will have ceased treatment when S26LBW Gold RFT is ultimately delisted from 1 April 2013. For new patients an alternative product, Preterm Post-Discharge Infant Formula (S-26 Gold Premgro) was listed fully subsidised under Special Authority restriction from 1 April 2012. Subsidy Changes The generic brand of candesartan (Candestar) will become the sole subsidised brand on 1st November 2012. The daily dose dispensing restrictions that currently apply candesartan will be removed from 1 August 2012. The Special Authority criteria for candesartan will also be amended from 1 August. Eformoterol fumarate powder for inhalation 6 µg per dose, Oxis Turbuhaler and 12 µg per dose, Foradil, will have an increased patient part-charge. However eformoterol in combination with budesonide (Symbicort) will remain fully funded but still subject to Special Authority criteria. Metoprolol – AFT CR has been awarded sole subsidised supply from 1 September 2012 and from that time Betaloc CR will no longer be subsidised; this is another reason to prescribe by generic name to avoid confusion . There price changes occurring for amino acid infant formulae however the two products, Elecare and Neocate will remain fully funded.

Steffan Crausaz appointed PHARMAC Chief Executive

PHARMAC Board chairman Stuart McLauchlan has announced the appointment of Steffan Crausaz as PHARMAC’s Chief Executive. Steffan Crausaz has been the Government pharmaceuticalfunding agency’s acting Chief Executive since September 2011, following the departure of Matthew Brougham. “The coming years will be challenging for PHARMAC as it takes on new and expanded roles” says Stuart McLauchlan. “PHARMAC is taking on a “The coming years will be greater role in relation to hospital medicines and medical devices, challenging for PHARMAC and has also been confirmed as as it takes on new and managing Government funding expanded roles” of vaccines from this month.” “We needed to select the right person to lead PHARMAC into this new era. We wanted a person with proven leadership skills, a strong understanding of the New Zealand pharmaceutical environment, experience working in and with Government, and a vision for how PHARMAC would build on its record of success. I am pleased to announce that Steffan Crausaz is that person.” Steffan has previously worked in a variety of roles across the pharmaceutical sector in New Zealand and in the UK. He joined PHARMAC in 2003, and led the team that manages the medicine funding activity including the negotiation of contracts with pharmaceutical companies. He has a Master degree encompassing pharmacoeconomics and pharmaceutical policy, as well as a Bachelor of Pharmacy, both from UK Universities.

Widening of Access

Dabigatran bottle presentation Dabigatran in the 110 and 150mg strengths will now be available in bottles rather than strips. This means that they can be put into blister packs where patients require this option. Felodipine long-acting tablet 2.5 mg – removal of restriction The daily maximum restriction that applies to felodipine 2.5 mg long-acting tablets will be removed from 1 July 2012. The ‘no more than 1 tablet per day’ restriction will be removed which will permit the subsidy of more than 1 felodipine (Plendil ER) 2.5 mg long-acting tablet per day.

---

Pharmaceutical Management Agency - Clinicians’ Newsletter - July 2012

PHARMAC Seminar Series - 2012

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 10 August 20 August 17 September 18 September 21 September Topic Travel Medicine Clinical Pharmacology for Nurses Common Paediatric Conditions Improving Cardiac Patient Management Across the Primary Secondary Interface Palliative Care Description This seminar is especially suitable (but not exclusively) for those who have some prior experience in the field. It will assume a basic working knowledge of the principles and practice of Travel Medicine Nurses involved in patient medication management and those looking to update their knowledge and understanding on how drugs work. GP’s, Practice Nurses, Plunket Nurses, Public Health Nurses and other Primary Care Staff. Primary Care Practitioners All health workers involved in palliative care in the primary care setting, in particular GPs, practice nurses and pharmacistsm

Pharmaceutical Management Agency

Feedback from delegates attending the seminars include:

“One of the best most practical seminars I have attended”

“Thoroughly informative, practical and relevant”

“All presentations outstanding – satisfied well above my expectations”

“Very well organised, great presenters and good to have access to resource and handouts. Good location and as always fabulous food”

inPharmation

PHARMAC publishes a quarterly email newsletter, inPharmation, which includes news and updates on developments around PHARMAC and pharmaceutical issues. If you would like to receive inPharmation, email Jessica@pharmac.govt.nz with inPharmation as your subject heading.

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

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)

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.