Inpharmation - July 2014
In this issue:
- From the Chief Executive
- PHARMAC and antibiotic resistance
- Supporting patients through medicine changes
- What is a ‘rare disorder’?
- Medicine brand changes and adherence
- New board member – Nicole Anderson
- Kaiwhakahaere Whakarata Māori
- New PTAC appointments
- Three new CAC members
- New vaccines funded 1 July
PHARMAC has been going through a period of growth and change this year while taking on additional work in hospital medicines, hospital medical devices and vaccines. This has led to new ways of doing things, increased expectations on us and a greater emphasis on engaging our stakeholders.
Stakeholder engagement is highlighted in our 2014/15 Statement of Intent. PHARMAC will be measuring the effectiveness of our stakeholder engagement because we know this is one of the foundations for the expanded work we’re now undertaking.
We will be consolidating and building on the strong foundations that have been built over the past year, like our new advisory committees and a new internal structure, so we can deliver value for New Zealanders from our work and decisions.
Our five strategies for future success, and the importance of Te Whaioranga, our Māori Responsiveness Strategy, are also highlighted in the SOI.
And PHARMAC will continue to focus on meeting its legislative objective – better health outcomes for New Zealanders from pharmaceuticals, from within the amount of funding provided.
Antibiotic resistance is a global health issue and New Zealand isn’t isolated from this growing problem.
PHARMAC supports efforts to combat resistance to antibiotics. While this work is led by the Ministry of Health, PHARMAC has taken steps to safeguard the prescribing of antibiotics so that they are better targeted to patients most in need.
Following clinical advice, PHARMAC placed targeting criteria on 94 of the 133 medicines listed in the hospital medicines list when it was first published in July 2013. This step is designed to reduce the unnecessary use of antibiotics in hospitals. Further work is planned, which will see prescribing rules in the community align with those in hospitals. The first of these steps occurred from 1 July 2014 when norfloxacin became targeted as a second-line agent.
Through the Best Practice Journal, PHARMAC is able to highlight the need to prescribe appropriately. This has included an antibiotics guide published July 2013 http://bpac.org.nz/Supplement/2013/July/antibiotics-guide.aspx(external link), and the most recent article on azithromycin prescribing published April 2014 https://www.bpac.org.nz/BPJ/2014/April/upfront.aspx(external link).
PHARMAC also continues to supply resources from the Wise Use of Antibiotics campaign (available at www.pharmaconline.co.nz(external link)); while the campaign website continues to be active at https://www.kickthatbug.co.nz/ [site since closed].
PHARMAC will continue to ensure it plays its part in ensuring New Zealanders continue to have access to these important medicines.
Pharmaceutical funding decisions can lead to people changing the brand of medicine that they take, and we recognise this can be difficult for people. PHARMAC is devoting more resources to helping ensure medicine changes are as clear and understandable as possible. To do this we are working with clinicians, practice nurses and pharmacists to help people adjust to changes in their medicine.
The PHARMAC website now features information about specific medicine changes in our My Medicine Has Changed section.
And in some cases, DHBs pay pharmacists a Brand Switch Fee as there is extra work for them to have conversations with patients about some medicine changes.
Some current changes PHARMAC is supporting include:
- Tacrolimus – working alongside transplant co-ordinators and transplant centres to help people adjust to a generic form of this immunosuppressant medicine.
- Fluoxetine – information for patients about this commonly-used antidepressant medicine.
- Capecitabine – an important oral medicine to treat cancers including bowel cancer is changing from the Xeloda brand to Capecitabine Winthrop.
- Growth hormone – the funded brand and the way in which patients receive their growth hormone are changing. The Omnitrope brand will become sole supply, and patients will be prescribed and dispensed their growth hormone from community pharmacy.
The definition of rarity is one of the questions PHARMAC is asking for people’s feedback on as it takes the next step towards trialling a funding process for medicines for rare disorders.
PHARMAC has released a draft Request for Proposals (RFP), which will lead into the competitive process it plans to trial, aimed at improving access to medicines for rare disorders.
The document outlines which medicines might be eligible, the types of disorders targeted and how the competitive process would run.
Consultation on the draft RFP is open until 25 July.
New Zealanders appear to adapt better to changes in their medicine than people in the United States, judging by some recently published research.
A study at Brigham & Women’s Hospital in Boston (reported at https://www.medicaldaily.com/generic-pill-size-and-shape-could-determine-whether-patient-will-adhere-medication-regimen-292958#.U8Vda3ryttU.twitter(external link)) shows that changes in the appearance of a medicine can lead to patients not taking them. The study reported that the likelihood of a patient discontinuing use or failing to refill their medication increased by 34 percent when the pill changed in colour and 66 percent when it changed in shape.
In New Zealand the vast majority of people take small differences such as changes in pill colour or shape in their stride. The US experience, as outlined in the study, isn’t shared in New Zealand.
This reflects the good work of community pharmacists in New Zealand, advising people about changes in their medicine and helping them to understand what any changes mean.
Nicole Anderson, a Hamilton-based consultant with a background in accountancy, health and business development, has been appointed to the PHARMAC Board.
A member of the NZ Institute of Directors, Nicole has worked primarily with organisations advancing Māori and iwi, and with various public sector and private organisations, focusing on policy and commercial development.
Nicole Anderson replaces Taranaki accountant Kura Denness on the Board, and ensures the PHARMAC Board will continue to have a Māori perspective.
Current Board membership details
Ātene Andrews has been appointed as PHARMAC’s first Kaiwhakahaere Whakarata Māori (Manager, Māori Responsiveness).
Ātene (Ngāti Porou) has joined PHARMAC after senior positions as Chief Advisor Māori at the Ministry of Business, Innovation and Employment, and at the Department of Labour prior to his MBIE role.
Ātene leads PHARMAC’s Māori Responsiveness Team, and oversees implementation of PHARMAC’s Māori responsiveness strategy, Te Whaioranga, which aims to embed responsiveness to Māori throughout all aspects of PHARMAC’s work. The team is also responsible for the He Rongoa Pai; He Oranga Whānau programme, which aims to improve understanding and uptake of medicines by whānau and Māori health providers.
PHARMAC’s commitment to the principles of the Treaty of Waitangi, and to continually improving how it interacts with and responds to the Māori community, is embodied in Te Whaioranga, a 10-year strategy that has been approved by the PHARMAC Board.
Te Whaioranga’s five primary objectives are to:
- advance tino rangatiratanga with whānau in health interventions
- establish and maintain authentic strategic connections
- champion evidence-based Māori medicine management
- support and engage in indigenous research and development about pharmaceutical management
- enhance and enable internal expertise and capability in Te Ao Māori.
Two new members have been appointed by the Director-General of Health to the Pharmacology and Therapeutics Advisory Committee, PHARMAC’s main clinical advisory committee. The new appointments, which take effect in July, are:
- Professor Jennifer Martin, incoming Chair of Clinical Pharmacology at the University of Newcastle
- Dr Simon Wynn Thomas, a Christchurch general practitioner.
For more information: Two new appointments to PHARMAC advisory committee
PHARMAC’s Consumer Advisory Committee (CAC) provides a patient or consumer perspective on PHARMAC’s work. Three new members have been appointed, all of whom come from a Pacific peoples health background.
The three new members have all been appointed for initial three year terms.
- David Lui – an Auckland health consultant with extensive links into Pacific peoples communities and health networks, and considerable experience in mental health and addiction sectors. He has more than 30 years’ experience working with Pacific communities in New Zealand and the Pacific. David was born, raised and educated in Samoa. He holds a degree from the University of Canterbury and has been appointed to CAC as the Pacific peoples’ representative.
- Tuiloma Lina Samu – Lina is from Mangere and was raised in a multi-cultural environment, including being educated at the local kura kaupapa. She is a health researcher (currently studying for a PhD at Massey University in Auckland), fluent in five languages, and with strong links to Pacific peoples’ and Māori communities in the Auckland region and nationwide.
- Key Frost – Key is a mental health advocate based in Invercargill. Key is a first generation New Zealander of Samoan heritage, with experience and knowledge of mental health issues and mental health networks (particularly in the South Island).
Vaccination continues to be an issue of high public interest, particularly with recent localised outbreaks of hepatitis A and measles. PHARMAC’s role is to secure supply of vaccines for the subsidised vaccination programmes, and new supply contracts came into effect from 1 July which will give New Zealanders secure supply of these important public health tools for three years.
Included in those contracts were two newly-funded vaccines, and changed or improved versions of some previously funded vaccines.
Rotavirus and varicella vaccines were added to the national immunisation schedule, along with an improved pneumococcal vaccine Prevenar 13. Rotavirus can cause severe diarrhoea in children, and immunisation is a vital tool in combating its spread and its impact on families. PHARMAC estimates that nationwide up to 1200 hospital admissions per year could be avoided through rotavirus vaccination.
Listing rotavirus vaccine is estimated to cost $6.3 million.
Read our media release: Rotavirus, varicella vaccines added to national immunisation schedule
Full details on the changes to vaccine funding are at: Changes to the National Immunisation Schedule
Last updated: 21 August 2019