Inpharmation March 2016
What should be the next medicine funded for New Zealanders? That’s the question PHARMAC engages with and we use well-established processes to help us.
We share people’s desire to have effective treatments available for those in need, and we want to make sure the choices PHARMAC makes are the best that can be made. Medicines funding can be an emotionally-charged issue, and patients, clinicians, families and communities will always seek the possibility of better outcomes. Independent clinical epidemiological advice is the bedrock of our funding decisions, helping us to understand the certainty of any long-term benefits that can be obtained for New Zealanders from new pharmaceuticals. We consider that this approach is in the best interests of New Zealanders, overall.
In healthcare there are always more things available to fund than there is funding available for them. And expectations of benefit can often exceed the clinical evidence. So we need to make choices.
We look carefully at the person’s health need, what other treatments might be available, what the benefit of the treatment is, and what the cost of the benefit is.
We can only spend the same dollar once – so we need to be sure the evidence for a medicine stacks up, and that it is affordable for the country.
That’s the only way we can be sure that what the Government spends on medicines is allocated fairly.
Funding for two new oral medicines will provide patients with more convenient options for treating multiple sclerosis.
From 1 February 2016, dimethyl fumarate (Tecfidera) and teriflunomide (Aubagio) are fully funded from first diagnosis for patients with relapsing-remitting multiple sclerosis (MS) who meet the listed criteria.
The new treatments provide further treatment options for patients with MS, following the funding of intravenous natalizumab and oral fingolimod in November 2014. The new medicines can be dispensed by a community pharmacy and taken at home by patients, without the need for an injection or infusions in hospital.
Patients currently receiving funded MS treatments can choose to stay on their existing treatment, or change to the new treatments if they meet the funding criteria.
About 800 patients currently receive funded MS treatments in New Zealand.
PHARMAC is funding six new medicines for people with the respiratory condition Chronic Obstructive Pulmonary Disease (COPD).
Agreements with two suppliers will see six new products funded:
- tiotropium bromide solution for inhalation (Spiriva Respimat)
- umeclidinium powder for inhalation (Incruse Ellipta)
- tiotropium bromide with olodaterol solution for inhalation (Spiolto Respimat)
- umeclidinium with vilanterol powder for inhalation (Anoro Ellipta)
- glycopyrronium with indacaterol powder for inhalation (Ultibro Breezhaler)
- fluticasone furoate with vilanterol powder for inhalation (Breo Ellipta).
In addition, PHARMAC is freeing up prescribing rules for some currently-funded COPD products so they will be available to more people – including allowing prescribing by qualified nurse prescribers.
The new products and changes to prescribing rules increase treatment options for people with COPD. They add to the four products currently listed for COPD, and with changes to prescribing rules, including the option of products being prescribed by suitably qualified nurse prescribers, PHARMAC is expecting the number of people receiving funded treatment for COPD to more than double from the current 22,000 over the next five years.
Depending on uptake rates of the new products, PHARMAC estimates that savings could be in the region of $10 million over five years. This is because price concessions that PHARMAC has obtained on existing products, combined with the new products listed, will generate savings in the long term.
The new products were listed on the Pharmaceutical Schedule from 1 March 2016.
PHARMAC is proposing to list the enzyme replacement therapy galsulfase (Naglazyme) on the Pharmaceutical Schedule. Galsulfase is used to treat the rare enzyme deficiency condition Maroteaux-Lamy Syndrome, or mucopolysaccharidosis (MPS) VI.
The proposal to list galsulfase is a result of PHARMAC’s medicines for rare disorders commercial pilot.
MPS VI is usually diagnosed in children and can cause damage to bones, joints, eyes, heart valves and the nervous system. PHARMAC’s expert clinical advisors considered that benefits from galsulfase may improve people’s quality of life, such as through enabling increased activity. Treatment may improve mobility, exercise tolerance, and preserve respiratory and cardiac function.
PHARMAC estimates that there would be about five people in New Zealand with MPS VI.
Consultation closed on 17 February..
Galsulfase would become the second enzyme-replacement treatment listed on the Schedule, with imiglucerase (Cerezyme) having been funded for many years for Gaucher disease.
PHARMAC listed icatibant, a treatment for hereditary angioedema, on 1 January 2016 as the first medicine funded from the rare disorders funding pilot.
Feedback from consultation is helping shape our future work on improving access to medicines and devices in primary care.
This work is a part of PHARMAC’s wider review of how some funded community medicines and devices are accessed by primary care providers, and supports the health system focus on ‘care closer to home’.
Consultation on our discussion document has led to PHARMAC deciding to maintain the current model for distributing vaccines for the time being. PHARMAC will continue to work through issues raised in consultation and work toward changes over future years.
The feedback also showed that there was considerable support for developing a model for other medicines and devices which address specific supply issues and streamlined funding for the administration of medicines in general practice.
PHARMAC will continue to work closely with the health sector to make improvements where we can, that are sustainable and work well for patients, general practice, PHOs and suppliers.
PHARMAC has reached further agreements with medical devices suppliers as its work in securing national contracts for hospital medical devices continues.
In the past few months PHARMAC has secured contracts with St Jude Medical and Obex Medical Ltd for interventional cardiology products, while a further agreement with Intermed Medical Ltd includes interventional cardiology, suture and wound care products, and we have recently sought feedback on a proposed agreement with Boston Scientific for interventional cardiology products.
PHARMAC has now reached national agreements in five medical device categories:
- Interventional cardiology
- Wound care
- Disposable laparoscopic devices
- Orthopaedics spine and trauma
A commercial process has also been run amongst suppliers of sterile wraps. In wound care products, PHARMAC is now looking to move to the next stage of national procurement which is to introduce further competition. PHARMAC called for proposals from suppliers in late 2015 and is currently assessing the proposals received.
PHARMAC continues to advance work to empower Māori communities to respond to their own specific health needs. PHARMAC supports this work through Memoranda of Agreement that provide support and funding for individual projects.
To date agreements have been reached with seven organisations – five Whānau Ora Collectives and two groups representing Māori health professionals.
The latest agreements to be signed were with an Auckland-based collective Kotahitanga, and with Te ORA, the Māori Doctors Association.
PHARMAC already has Memoranda of Agreement with four Whānau Ora collectives in Bay of Plenty, Rotorua, and Te Taitokerau, and with Ngā Kaitiaki o Te Puna Rongoā ō Āotearoa, the Māori Pharmacists Association.
Those agreements have enabled the collectives to run health programmes of specific importance to their communities. For example, in Tauranga the agreement has supported wānanga on respiratory illness and mental health, while in Opotiki the community decided to highlight gout as a health issue.
For Māori doctors and Māori pharmacists, the agreements help support initiatives to encourage and support Māori in the health workforce.
Agreements are open-ended.
Last updated: 15 May 2017