Supporting transitional funding for newly funded cancer treatments in private hospitals and clinics
What we’re proposing
We’re proposing rule changes to implement the Government’s policy for certain funded cancer medicines to be administered in private hospitals and clinics from 1 July 2025. This would be available for people who are on, or are about to start, treatment in a private facility when Pharmac funds the medicine.
Please note that this consultation is not proposing a change in Government policy – a decision on that matter has already been made by the Government. More information on this policy change can be found on the Ministry of Health website.
Consultation closes at 5 pm on Friday 13 June 2025 and feedback can be emailed to consult@pharmac.govt.nz or submitted via our online form.
What would the effect be?
From 1 July 2025, Health NZ hospitals would be able to supply newly funded cancer medicines (those where funding begins on or after 1 July 2025) to private facilities to administer to their patients, where either:
- the person is already receiving treatment at the date that the medicine becomes funded by Pharmac, or
- the person has an approved treatment plan, and is about to start treatment, at the date that the medicine becomes funded by Pharmac.
Funded medicine could be supplied to a private facility for the remainder of a person’s treatment course, for up to 12 months.
Who we think will be interested
- People with cancer, their whānau, and caregivers
- Oncologists, haematologists, pharmacists, and other health professionals working in Health NZ hospitals and private facilities
- Private providers of cancer services
- Pharmaceutical suppliers
- Health NZ | Te Whatu Ora and the Cancer Control Agency | Te Aho o Te Kahu
- Support and advocacy groups
About hospital-administered cancer treatments
Cancer medicines that need specialist administration, such as by intravenous infusion, are only subsidised by Pharmac when used in a Health NZ hospital.
Unfunded medicines are not administered in Health NZ hospitals. This means that if someone is prescribed an unfunded cancer treatment that needs specialist administration, it must be administered in a private hospital or clinic.
Because of this, when Pharmac funds a new cancer medicine, there may be some people who have already started treatment in a private setting. Currently, for them to benefit from Pharmac’s funding decision, they must transition back into the public system midway through their treatment.
While Pharmac eligibility criteria support this transition where necessary, there can be delays in accessing publicly funded treatment. These can occur when there are direct resource implications of the newly funded medicine that cannot be accommodated in the New Zealand public health system.
Why we’re proposing this
The Government has decided to provide transitional funding for cancer medicines to support access for all New Zealanders after a new medicine is funded by Pharmac.
This would allow people currently receiving a cancer medicine in private facility, to stay at the facility and receive the newly funded medicine. This will be available to people:
- already receiving the medicine privately or
- with treatment scheduled to begin within a month of the medicine being funded.
People would be able to finish their treatment course at the facility for up to 12 months from the date the medicine was publicly funded.
To give effect to this decision, Pharmac needs to change the Pharmaceutical Schedule rules and allow Health NZ hospitals to supply funded cancer medicines to private facilities.
Details about our proposal
The General Rules of the Pharmaceutical Schedule would be amended as follows, with effect from 1 July 2025 (additions in bold):
3.1.2 Health NZ Hospital Contractors:
- Contractors with an agreement to claim Hospital Pharmaceuticals can dispense and claim for Community Pharmaceuticals marked as “PCT” or “PCT only”.
- Health NZ Hospital Contractors can claim subsidies for pharmaceuticals pursuant to these General Rules and the terms outlined in the Service Level Agreement previously entered into for the Dispensing of Pharmaceutical Cancer Treatments.
- Health NZ Hospital Contractors can only claim subsidies in respect of:
- Patients directly under the care of a Health NZ Hospital, and
- Pharmaceuticals provided to private facilities that have been approved by the Ministry of Health to provide transitional access to funded cancer treatments.
Health NZ hospitals would be able to supply medicines to eligible private facilities and claim a subsidy from Pharmac in the same way as for medicines delivered within a Health NZ hospital.
To provide feedback
Send us an email: consult@pharmac.govt.nz or complete our online form by 5 pm on Friday 13 June 2025.
All feedback received before the closing date will be considered by Pharmac’s Board (or its delegate) prior to making a decision on this proposal.
Your feedback may be shared
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