Table 2

Summary of issues

General medicines policyEthnicityPHARMACTPPAHCM
▸ By whom and how are decisions made?
▸ Poor medicines policy awareness
▸ Poor health literacy; impacting timing of presentation and medicines adherence
▸ Access to prescribers; physical, timing and affordability
▸ Socioeconomic factors (encompassing rural residents)
▸ Sole supply; out of stock vulnerability and cost, options for intolerance
▸ Discord in recommendations between PTAC and subcommittees
▸ Access challenges on the ability to pay for litigation; non-medical person then decides access
▸ Lack of health impact monitoring
▸ Need for integrated electronic patient records, prescribing information and PHARMAC schedule
▸ Efficiency is static; needs to move towards increases in therapeutic benefit
▸ Registration, evidence and manufacturing requirements constraining for low demand medicines
▸ Increasing demand and cost of medicines impacting affordability
▸ Need for clinical expertise and New Zealand specific research
▸ Need for better medicines management 
▸ Socioeconomic factors
▸ Need to use ‘Health Equity Assessment Tool’ to assess policy and inequities/inequalities
▸ Higher burden of disease for Māori and Pacifica; needing risk factor lens
▸ Lacking proper engagement at times
▸ Cultural competency
▸ Use of complementary medicine
▸ Need to capture ethnicity statistics in new initiatives 
▸ Very powerful position of provision; will they cope with role expansion?
▸ Young inexperienced staff and high attrition rate
▸ What health outcomes are being measured?
▸ Is the lost health opportunity being measured?
▸ Budget too small; need higher percentage of health budget; ‘Vote Health’
▸ Cost driving value and causing delays
▸ Need to move to dynamic efficiency
▸ Need analytical framework to compare all health technologies
▸ Submission process inefficient
▸ Economic evaluation influencing therapeutic value evaluation; need to be separated
▸ Questionable how well health professionals understand pharmacoeconomic modelling
▸ In-house economic variables are not necessarily consistent with standard practice or PHARMAC's requirements of suppliers
▸ Hard for suppliers to understand outcome or evaluation process when variables changed
▸ Website very informative but hard to navigate
▸ Concern with expansion into hospitals and limiting choice in acute care and moribund disease setting
▸ Sustainability of current access with increasing demand
▸ Affordability of a panacea 
▸ Many unfamiliar and sceptical of the benefits and who gets them vs the trade offs
▸ New Zealand, a small country that needs trade partners
▸ Where will the financial cost be felt and how will it be dealt with?
▸ Will there be an increase in the cost of provision?
▸ A lot of money is being spent on health already and the benefits are low
▸ Australia lost a lot with their agreement with the USA; we should learn from it
▸ America's influence is reducing and other forms of protection may evolve
▸ Patent extensions will delay generic entry and raise costs
▸ Will the pharmaceutical industry have a greater influence on supply?
▸ Access to new medicines may improve
▸ Sovereignty of choice; will there be increased public appeals and litigation?
▸ What does transparency mean and does it ‘cut both ways’?
▸ PHARMAC's monopsony is an anathema to the USA
▸ NZ pharmaceutical representative educating ‘sister’ organisation in NZ system
▸ Once a medicine is registered for use, it can be prescribed; PHARMAC may choose to not fund it 
▸ Special Authority access unnecessary once appropriate prescribing established
▸ Need to differentiate high cost vs highly specialised need and cost
▸ NPPA access scheme brings equitable access for oncology but too early to assess
▸ NPPA capturing patient sub-type classification
▸ NPPA process inefficient and consuming valuable specialist time
▸ Limits access due to cost; but about collective good and who pays
▸ Access cheaper in other countries?
▸ Pharmaceutical companies have good profit margins
▸ Oncology stigma that everyone dies but differences in survival seen at the margins
▸ Evidence does not meet PHARMAC's evaluation criteria
▸ Constraints of ‘rule of rescue’ vs utilitarian provision
  • HCM, High Cost Medicines; NPPA, Named Patient Pharmaceutical Assessment; NZ, New Zealand; PHARMAC, Pharmaceutical Management Agency; PTAC, Pharmacology and Therapeutics Advisory Committee; TPPA, Trans Pacific Partnership Agreement.