Decision to enable transitional funding for newly funded cancer treatments in private hospitals and clinics
What we’re doing
From 1 July 2025, people in private facilities will be able to receive newly funded cancer medicines for up to 12 months where either:
- they are already receiving treatment at the date that their medicine becomes funded by Pharmac, or
- they have an approved treatment plan and are about to start treatment, at the date that their medicine becomes funded by Pharmac.
Any changes to the original proposal?
This decision was subject to a consultation letter dated 26 May 2025. Thank you to everyone who provided feedback – we received a large amount of feedback on the proposal. We are grateful for your feedback – it has had an impact on our decision.
We had initially proposed that private facilities would be able to obtain the funded medicine from public hospitals, as private hospitals cannot currently make subsidy claims for cancer medicines as public hospitals do. As a result of the feedback that we received, we have now decided to implement this decision in a different way.
- Initially, Pharmac will work with private facilities to implement a direct payment arrangement for cancer medicines that fall under this policy. This will mean that they can continue to order medicines from their regular compounding pharmacy.
- In the future, Pharmac will work with private facilities, Health NZ, and suppliers to consider establishing a subsidy claiming mechanism for these medicines, similar to that used by public hospitals to claim for ‘PCT’ medicines.
Who we think will be most interested
- People with cancer, their whānau, and caregivers
- Oncologists, haematologists, pharmacists, and other health professionals working in public hospitals and private facilities
- Private providers of cancer services
- Pharmaceutical suppliers and compounders
- Health NZ | Te Whatu Ora and the Cancer Control Agency | Te Aho o Te Kahu
- Patient support and advocacy groups
Our response to what you told us
Thank you to the people who took the time to respond to this consultation. A summary of the main themes raised and our responses follows.
Most of the responses were supportive of the objective of this change, with many suggesting changes to how it could work.
Transitional access policy
You told us
- People considered that this would help to maintain continuity of care for people who have already started treatment with a newly funded cancer medicine in a private setting. People also considered that this change would reduce the number of people moving from private facilities to public hospitals, easing the initial burden on public hospital infusion clinics.
- Some respondents considered that the proposal could create inequities in access to cancer medicines, and that timely care may become dependent on ability to pay. Some considered that building capacity in the public system needs to be a priority, either instead of or in addition to this change.
- Many respondents considered that the policy for transitional access to cancer medicines should be amended or broadened, and suggested the following changes:
- extend the policy to include cancer medicines that were funded in the last year
- remove the 12-month time limit on transitional access
- fund administration costs as well
- enable any cancer medicine, not just newly funded ones, to be funded in private facilities
- fund non-cancer medicines through this mechanism.
Our response
We appreciate all of the feedback that people provided during this consultation. While Pharmac was only consulting on the change to the Pharmaceutical Schedule to implement this policy, we have shared people’s wider feedback about the policy with the Ministry of Health for their consideration.
Implementation
You told us
- Respondents considered that the proposed approach to enabling funded access would create additional workload for people involved in ordering and administering cancer medicines, and that the process had the potential to create patient safety risks.
- Respondents considered that the preferred situation would be for private facilities to directly order cancer medicines and submit subsidy claims to Pharmac.
Our response
We acknowledge the concerns raised regarding the proposed approach and intend to work with private facilities to implement a more direct funding arrangement.
We note that private facilities cannot submit a subsidy claim in the same way as public hospitals do. IT system changes across the sector would be required to make this happen. In the meantime, we will establish an interim payment arrangement to support transitional access and will be in contact with private facilities to set this up.
This new approach aims to avoid pharmacists at public hospitals having to manage the procurement and claiming for cancer medicines that are not being delivered in the public hospital.
Questions
If you have any questions about this decision, you can email us at enquiry@pharmac.govt.nz; or call our toll free number (9 am to 5 pm, Monday to Friday) on 0800 660 050.