<< Decision Making Process

Decision Criteria

In deciding which medicines to fund, PHARMAC seeks to balance the needs of patients’ access to healthcare against its responsibilities to the taxpayer. Given PHARMAC is managing taxpayer funding, PHARMAC’s decisions need to represent good value for money for the benefit of all New Zealanders.

PHARMAC uses the criteria set out below, where applicable and giving such weight to each criterion as PHARMAC considers appropriate, to make decisions about proposed amendments to the Pharmaceutical Schedule. Where PHARMAC makes decisions that do not involve amendments to the Schedule (for example, decisions relating to PHARMAC’s access and optimal use activities), it endeavours to use these criteria, to the extent that they can be applied to those decisions. The criteria for decisions about proposed amendments to the Schedule are:

1. The health needs of all eligible people within New Zealand;
2. The particular health needs of Maori & Pacific peoples;
3. The availability and suitability of existing medicines, therapeutic medical devices and related products and related things;
4. The clinical benefits and risks of pharmaceuticals;
5. The cost-effectiveness of meeting health needs by funding pharmaceuticals rather than using other publicly funded health & disability support services;
6. The budgetary impact (in terms of the pharmaceutical budget and the Government’s overall health budget) of any changes to the Schedule;
7. The direct cost to health service users;
8. The Government’s priorities for health funding, as set out in any objectives notified by the Crown to PHARMAC, or in PHARMAC’s Funding Agreement, or elsewhere; and
9. Such other criteria as PHARMAC thinks fit. PHARMAC will carry out appropriate consultation when it intends to take any such “other criteria” into account.

All subsidised medicines are published in the Pharmaceutical Schedule, which is managed by PHARMAC.

Page updated on 08 May 2009