How medicines are funded

PHARMAC has an established process for deciding which medicines to fund. We consider Pharmaceutical Schedule funding applications from pharmaceutical suppliers, health professionals, consumer groups and patients.

How a medicine or medical device is assessed for funding by PHARMAC

Description of "The journey of a funding application"

A medicine supplier, health professional or an everyday New Zealand can apply for a medicine device to be funded.

  1. Prepare your application by collating all relevant information.
  2. Discuss your application with someone from PHARMAC.
  3. Submit your application via PHARMConnect.
  4. Review: PHARMAC reviews and evaluates the evidence, including others' submissions on the same medicine or medical device.
  5. Advice: PHARMAC receives recommendations from independent clinical experts from across New Zealand's healthcare sector who sit on the Pharmacology and Therapeutic Advisory Committee (PTAC) and its subcommittees.
  6. Assess: PHARMAC considers the clinical advice and assesses the medicine. Reasearch and economic analysis take place. 
  7. Compare options: PHARMAC compares and ranks medicines, high to low.
  8. Prioritise: A prioritised list of medicines for funding is created.
  9. Identify: PHARMAC identifies which medicines on the list to take forward.
  10. Negotiate: PHARMAC negotiates price with suppliers.

The Minister sets a fixed budget, so the agreed price must be affordable. 

  1. Provisional agreement: PHARMAC and the supplier confirm a provisional agreement.
  2. Consult: We ask New Zealanders what they think.
  3. Consider submissions.
  4. Final changes: PHARMAC staff make any changes necessary following the consultation submissions.
  5. Final decision: The PHARMAC board or delegate makes a final decision. 
  6. Notification: PHARMAC notifies the decision to health professionals and the public.
  7. Listed: If approved, the medicine or medical device is listed on the Pharmaceutical Schedule. 

PHARMAC's Factors for Consideration are used throughout this process.

You can see the status of your application in the Application Tracker

Download: Funding process on a page  [PDF, 534 KB]

Disclaimer: The process set out in this diagram is intended to be indicative of the process that may follow where a supplier or other applicant wishes a pharmaceutical to be funding on the Pharmaceutical Schedule. PHARMAC may, at its discretion, adopt a different process or variations of the process. For example, we decide whether or not it is appropriate to undertake consultation on a case-by-case basis. 

Note that implementation of a decision includes both positive and negative funding decisions. These may include notification of a Schedule listing or listing that an application has been declined.

 

Last updated: 18 March 2020

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