Paediatric Oncology Funding Policy

Purpose

The Pharmaceutical Schedule describes the situations under which a Subsidy is payable and/or a product can be used in a Health New Zealand Hospital.

In general, a Health NZ Hospital may not Give an Unlisted pharmaceutical, or a Hospital Pharmaceutical outside of any relevant Restrictions. However, the Pharmaceutical Schedule provides a number of exceptions. Paediatric Oncology is one such exception.

This policy provides an exception pathway that enables access to publicly funded cancer medicines outside of Pharmac's usual funding assessment and decision-making processes.

This policy confirms the existing arrangements for children receiving treatment in paediatric oncology and haematology services, and establishes an additional access pathway for adolescents and young adults (AYA) with paediatric-origin cancers.

Scope

Funding applies through two pathways:

Pathway One: Children receiving cancer treatment in paediatric oncology/ haematology services

Children receiving treatment for cancer within New Zealand's two recognised paediatric oncology and haematology services remain eligible for access to funded cancer medicines under existing arrangements.

Pathway Two: Adolescents and young adults with paediatric-origin cancers

In addition to the existing pathway for children, access to funded cancer medicines may be available for adolescents and young adults (AYA) with paediatric-origin cancers.

To be eligible, all three of the following criteria must be met:

Criterion 1: Paediatric-origin cancer

The patient has a cancer included on Pharmac's defined list of paediatric-origin cancers (refer Appendix One).

Criterion 2: Paediatric-based treatment protocol

The patient is being treated using a paediatric-based treatment protocol.

This requirement applies regardless of whether treatment is delivered within a paediatric or adult haematology/oncology service.

Criterion 3: Eligibility for AYA cancer services

The patient is eligible for AYA cancer services under the Health New Zealand Tier 3 Service Specification.(external link)

Clinical Oversight

Eligibility under the AYA pathway should be determined through established clinical governance processes, including multidisciplinary team or multidisciplinary meeting (MDT/MDM) review, where appropriate. Where MDT/MDM review occurs, it should support:

• confirmation of a paediatric-origin cancer
• use of a paediatric-based treatment protocol
• eligibility under the AYA cancer service framework.

Application of Health New Zealand AYA Service Eligibility

Eligibility for AYA cancer services is determined in accordance with the Health New Zealand Tier 3 Service Specification.

Where a patient is accepted into AYA cancer services under the flexibility provisions of the Tier 3 Service Specification, eligibility under this policy may be considered, provided all other requirements of this policy are met.

Notification requirements

Use of medicines under this policy must be notified to Pharmac through completion and submission of the approved Paediatric Oncology Funding Policy Notification Form by the treating clinician, pharmacist, or authorised delegate.

Notification requirements apply to:

• children receiving funded cancer medicines in paediatric oncology/haematology services
• adolescents and young adults accessing funded cancer medicines through the AYA pathway.

The current notification form is available on Pharmac's website.

Information collected through the notification process may be used by Pharmac for monitoring, forecasting, implementation, and policy review purposes.

Submission of a notification form does not constitute a request for approval and does not affect eligibility for access under this policy and the Schedule rules.

Review and publication

This policy will be reviewed every three years, or more frequently if required. Pharmac may review and amend this policy following clinical advice, changes to AYA service eligibility settings, emerging treatment approaches, or operational experience with the policy. Any review will follow Pharmac's standard process for the review and development of organisational policy.