In 2017, we launched 3 ambitious goals to be achieved by 2025:
- eliminate inequities in access to medicines
- generate $1 billion of savings from medical device management, to reinvest in health outcomes for New Zealanders
- create systems that enable the best investment choices to be inplemented across all PHARMAC activities.
Here's an update on some of the work that's underway towards these goals.
1. Eliminate inequities in access to medicines
Not all New Zealanders are achieving best health outcomes from medicines funded by PHARMAC.
We know that Māori have significant barriers in accessing funded medicines, as do Pacific peoples. Deprivation and rurality are likely to be important factors too.
This year, through literature reviews and other feedback, we focused on identifying the key barriers to equitable medicines access. This was an important first step, as being clear about the drivers of inequity is crucial to developing effective solutions.
The five key barriers identified were:
- availability – how PHARMAC makes funding decisions so that everyone who is eligible can access funded medicines
- affordability – cost barriers mean people can’t afford funded medicines
- accessibility – challenges getting to see a prescriber or to the pharmacy
- acceptability – the ability of health services to create trust, so patients are informed and engaged enough to accept the medicines they’ve been prescribed
- appropriateness – the adequacy and quality of prescribing to ensure equitable health outcomes.
Some solutions to these barriers will be within PHARMAC’s control – others will see us playing an influencing or supporting role.
Good partnerships will therefore be crucial to achieving our bold goal, so this year we also focused on building and strengthening the relationships we’ll need to jointly tackle the drivers of medicines access inequity.
An example was teaming up with the Health Quality and Safety Commission (HQSC) to launch Whakakotahi 2019 – a challenge which calls on primary care providers to propose improvement projects, with successful applicants receiving support to implement their project.
Three of the projects that will be supported as part of the 2019 challenge will have a medicine access equity focus.
2. Generate $1 billion of savings from medical device management to reinvest in health outcomes for New Zealanders
More medical devices used by DHBs were brought under national contracts this year, which means any DHB can purchase the contracted items under common terms for things like price, maintenance and supply.
We have a total of over 93,000 hospital medical device line items, from over 60 suppliers, listed in the Pharmaceutical Schedule. All contracting to date is expected to save $55.41 million over 5 years.
As well as delivering immediate benefits to DHBs, the work we’ve been doing has also enabled us to keep deepening our understanding of the types of products currently in use across DHBs.
This is important, as the Government’s decision to apply the PHARMAC management model to DHB hospital medical devices means we will eventually be responsible for deciding what devices are used or provided by DHBs - either within hospitals or the community - are publicly funded.
In time, our approach to making device funding decisions will bear many similarities with the approach we currently use for medicines. For example, decisions will be based on our Factors for Consideration, which means we will assess the need, benefits, costs and savings and suitability of a particular device, including how these apply to the individual requiring treatment, their family/whanau and wider society, as well as the broader health system.
However, we also recognise that there are significant differences between medicines and devices. For example, some devices have unique servicing and maintenance requirements, so our approach to device funding decisions will be tailored to take these into account.
We’re currently preparing to consult from March next year on the next step in our proposed approach to managing funding decisions for hospital medical devices.
This will mark a significant step forwards in our device management work, so we’ll be engaging with DHBs early in the new year to raise awareness of the consultation. We want to encourage as much participation and feedback as possible to help shape our approach.
3. Create systems that enable the best investment choices to be implemented across all PHARMAC activities
Getting the best outcomes from the decisions we make depends on the right systems and processes being in place to support those decisions – not just within PHARMAC, but across the wider health sector too.
The work we’re doing towards this goal therefore involves changing how we do things, and how we work with others, to achieve our goal of delivering the best health outcomes for New Zealanders.
This year saw a major change when the responsibility for managing expenditure on hospital medicines was transferred from DHBs to PHARMAC.
With hospital medicines now included in the Combined Pharmaceutical Budget (CPB), we have the ability to deliver even greater savings which can be reinvested in the health of New Zealanders.
Within PHARMAC, we’re working on a new online system for the receipt of pharmaceutical funding applications and at the same time making it easier for people track the status of an application.
(Gross spend $millions, exclusive of GST and rebates)
Last updated: 13 December 2018