Challenges ahead

Nowhere is the challenge of balancing these three factors more obvious than in the area of medical devices, where PHARMAC is responsible for securing access to an increasingly broad range of devices for use in public hospitals.

“PHARMAC is in its infancy in regard to devices,” says Carl Burgess, former chair of PHARMAC’s Pharmacology and Therapeutics Advisory Committee.

“It’s going to take them time and it is not going to be easy because of the differences in hospitals’ use of devices.”

Convergence of drug and device technology will also require new approaches from PHARMAC, says founding general manager David Moore.

“The next challenge is where pharmaceuticals start to integrate with medical devices and in turn how medical devices integrate with information technology,” he says.

The era of personalised medicine, the move away from a ‘one size fits all’ approach to treatment and care of patients with a particular condition would usher in many promising new treatments for diseases like cancer, he says.

“Cancer drugs are now a huge part of the Pharmaceutical Schedule and there will be more of them. You are increasingly seeing them linked to biomarkers – personalised medicine.”

Dealing with innovative new treatments is nothing new for PHARMAC. In the last decade it has adapted to accommodate a growing number of biologic medicines, which are made from living yeasts, bacteria or animal cells and are used in insulin to treat diabetes, hormones and drugs for cancer, arthritis and a range of auto-immune disorders.

“They are not like the old chemical entities,” says Moore. “They’ll take more personalisation.”

Former PTAC member Sharon Kletchko says the nature of research in medicines and new treatments is changing, with more international collaboration that could have implications for how medicines come to market in future.

“All of the groundwork in biological research, genetic research, proteomics is being looked at through a public health lens. Data has become a free public good internationally,” she says.

Pharmaceutical companies would still play a major role in developing drugs, but the market power they have in future, as an array of new treatments emerge, is uncertain.

“We are entering into a world where value per dollar invested is going to be much more real,” predicts Kletchko.

“Nobody is afraid of paying the true cost with a return. But the return has to be a just return.”

New treatments won’t lessen the key challenge of getting people to engage with their own health care,” says PHARMAC’s former medical director, Peter Moodie.

“It’s tempting to think that medicine will solve everything and that’s just not the truth.”

He points to the treatment of diabetes, the largest and fastest-growing health issue the country faces.

“What becomes obvious is that the new pharmaceuticals aren’t the question. It is getting people to understand what their disease is and using the pharmaceutical efficiently,” says Moodie.

That would mean that PHARMAC’s advocacy and education programmes would have to evolve and become more sophisticated to meet the changing needs of consumers and community health providers.

“There are new methods of helping patients overcome problems they may have and it is more than just drugs,” agrees former PHARMAC Board chair Richard Waddel.

All agree that a fundamental challenge will be keeping the successful model of the last 25 years intact to face the next quarter century of delivering subsidised medical treatments to New Zealanders.

“My hope for PHARMAC would be that it keeps its integrity as an honest broker of the tension between getting the right access to medicines, vaccines and medical devices and the need to not be ripped off,” says former chief executive Steffan Crausaz.

“There’s huge potential scope for that.”