No new funds to improve access to high-cost medicines in New Zealand
This article was originally published in Scrip
No more funding for high-cost medicines in New Zealand looks forthcoming after a new report found no evidence that health outcomes are worse there overall than for comparable countries.
"We do not recommend that new prioritisation processes and pools of funding be established for high-cost, highly specialised medicines per se," says a report published last week that was commissioned by the country's minister of health in May 2009. High-cost medicines usually cost in excess of NZ$20,000 per patient per year.
The report – written by a three-member panel which describes itself as "outsiders looking in" at New Zealand's medicines systems – offers 17 recommendations, which the government will digest alongside those from a ministerial review group.
The report says funding decisions concerning high-cost and/or highly-specialised medicines should continue to be made in the same way as decisions for other medicines, subject to the report's other recommendations that are aimed at improving how such decisions are made in future.
The report offers three options to help improve access to high-cost medicines – increased government spending, increased patient co-payments on prescriptions or reduced wastage (better value for money) in the medicines/health system. It prefers the last option, although does not discount the first two.
The report also recommends that the schemes in place for assessing high-cost drugs need to be simplified, so that the multiple pharmaceutical schedules and exceptional circumstances schemes be replaced by a single "New Zealand Pharmaceutical Schedule" covering community, cancer and hospital drugs and a single Exceptional Circumstances scheme.
It recommends that Pharmac, the drug-subsidy body, be responsible for the assessments and funding decisions of all drugs on the proposed New Zealand Pharmaceutical Schedule and the Exceptional Circumstances scheme. This means that in addition to community medicines, Pharmac would also take responsibility for all hospital and cancer drugs.
However, it is also advises that Pharmac be directed to fund second-line and perhaps third-line drugs within a therapeutic subgroup, so that most patients who do not benefit from the first-line agent have an alternative treatment available.
Overall, district health boards will continue to be responsible for managing their total spending on drugs through the proposed New Zealand Pharmaceutical Schedule and Exceptional Circumstances scheme, the report says.
The report also recommends that low-cost highly-specialised drugs are more readily available in New Zealand than they are now.
The Researched Medicines Industry Association welcomed the report: "We will be taking time to study the recommendations in detail but we are encouraged that the panel have listened carefully and objectively to all the submissions made." It added that the Pharmac model needs to evolve in order to address the "ever increasing gap between New Zealand and the rest of the world in terms of access to medicines".
The government is also receiving advice on the possible expansion of Pharmac's role into areas of hospital medicines, vaccines and some medical devices as recommended by the ministerial review group. "These two pieces of work cover some similar areas, so we will be considering all of the advice together, and making announcements before the end of the year," the ministry of health said.