Decision Criteria review
As part of a rolling review of our operating policies and procedures (OPP), PHARMAC has reviewed our decision criteria. The outcome of this review is a new decision-making framework.
The Decision Criteria
During 2013/14 PHARMAC carried out a comprehensive review of its Decision Criteria, including proposed changes. We consulted widely across New Zealand as part of this review.
The outcome of this review was a change to the way PHARMAC makes funding decisions, with new Factors for Consideration replacing the Decision Criteria.
Introducing the Factors for Consideration
The Factors for Consideration replace the Decision Criteria from 1 July 2016. The Factors help us determine if a funding decision would help us to achieve our Statutory Objective.
More details on the new factors can be found in Changing the way we make decisions - the Factors for Consideration.
Implementation of the Factors
The Factors for Consideration were announced in November 2014 and came into effect on 1 July 2016. This new decision-making framework is a big change for PHARMAC, and requires a long lead-in time to ensure a smooth transition from using the Decision Criteria to using the Factors for Consideration.
PHARMAC undertook significant engagement externally, before implementating the Factors, to help familiarise people with them.
June and August 2013: first round of consultation
PHARMAC held our first round of consultation from June to August 2013. This consultation included a series of 12 community forums at different locations around New Zealand.
Following the first round of consultation, PHARMAC developed a proposal for change to the Decision Criteria. A stakeholder event held in April 2014 also provided an opportunity for stakeholders to feed back on the proposal for change.
PHARMAC has now published a summary of submissions to reflect back what we heard in this round of consultation. We are considering these submissions and will be presenting the final decision later in the year.
If you would like further information, please email us at email@example.com.
PHARMAC’s Decision Criteria
Until 1 July 2016, PHARMAC used the criteria set out below, where applicable and giving such weight to each criterion as PHARMAC considered appropriate, when making decisions about which pharmaceuticals are available for public subsidy:
- The health needs of all eligible people;
- The particular health needs of Māori and Pacific peoples;
- The availability and suitability of existing medicines, therapeutic medical devices and related products and related things;
- The clinical benefits and risks of pharmaceuticals;
- The cost-effectiveness of meeting health needs by funding pharmaceuticals rather than using other publicly funded health & disability support services;
- The budgetary impact (in terms of the pharmaceutical budget and the Government’s overall health budget) of any changes to the Schedule;
- The direct cost to health service users;
- 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 [Tell me more about the Government's health priorities]; and
- Such other criteria as PHARMAC thinks fit.
One of PHARMAC’s previous nine decision criteria (criterion eight) was “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”.
The Ministry of Health advised PHARMAC to use the Ministry of Health’s Statement of Intent to identify those priorities. For the purposes of decision criterion eight, the Government priorities were those outlined in the Ministry of Health's Statement of Intent.
In addition to asking people to make submissions using our online consultation tool, we held a series of community forums to seek the community’s views face to face.
We also arranged times to meet with people who wanted to discuss their feedback with PHARMAC staff but were unable to attend a community forum event.
Consulting on criteria for funding medicines
The video was filmed at the first of the community forums, in Auckland, on 25 June 2013.
Last updated: 7 February 2020