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.

Process for listing a new pharmaceutical

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 funded 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.

PHARMAC's decision making process

Text version of the process diagram

Application tracker is updated during the application.

Prepare application (supplier, consumer, clinician)

  1. Discuss application with PHARMAC staff
  2. Submit application

Consider evidence (PHARMAC and clinical advisors) using factors for consideration

  1. Review application, collate additional information and undertake preliminary analysis
  2. Either or both:
    • PTAC advice
    • Subcommittee or other clinical advice
  3. Recommendations:
    • Positive
    • Decline

Assess relative value (PHARMAC) using factors for consideration – prioritisation

  1. Research and assess information on factors for consideration
  2. Rank application against other applications
  3. Either:
    • PTAC review
    • Board review

Negotiate (PHARMAC and supplier)

High ranking

  1. Further development of proposal
  2. Either:
    1. Provisional agreement
    2. No current action or consult on decline

Low ranking

  1. No current action or consult on decline

Consult and decide using factors for consideration

  1. Consider submissions
  2. Either:
    • Amend proposal as necessary, then PHARMAC Board or delegate decision
    • PHARMAC Board or delegate decision
    • Proposal not progressed

Implement

  1. Notify decision
  2. Activate implementation plan for Schedule decisions

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: 31 August 2016