Pharmac confirms changes to simplify biologic medicine funding criteria

The changes will reduce administrative workload for clinicians, improve consistency across biologic treatments, and reflect feedback received through consultation.

“We’ve listened to feedback from clinicians, patient advocacy groups, and others,” says Pharmac’s Acting Manager of Pharmaceutical Funding, Claire Pouwels. “These changes make the criteria easier to use and more consistent across similar treatments.”

The changes include:

• extending how long Special Authority approvals last
• allowing any relevant health practitioner to apply for funding
• removing renewal requirements for some conditions
• aligning wording and removing outdated clinical references
• simplifying criteria to support more consistent access. 

Pharmac received 9 responses to the consultation. Feedback was positive, and some clinicians suggested further refinements - like extending some approval periods, removing requirements that weren’t needed, and updating or simplifying criteria to better reflect clinical practice. We've made some changes to our final decision as a result of this feedback.

 “Fewer administrative steps mean less waiting, fewer interruptions to treatment, and more consistent access to care” says Pouwels

Pharmac previously updated access criteria for adalimumab in 2021, and many stakeholders asked for similar improvements to be made to other biologic medicines including infliximab, etanercept, secukinumab, and rituximab.

More information

Special Authority and Hospital Indication Restrictions are funding tools used by Pharmac to ensure medicines are targeted to those who would benefit most. They set out specific clinical criteria that must be met before a person can get a funded medicine.