Deborah Gleeson raises some interesting points about the potential effects of free trade agreements on access to medicines in New Zealand (US proposal on Pharmac a bitter pill). However, we suggest that real life patient outcomes should be at the heart of any discussion about access to medicines.

As the industry association representing pharmaceutical firms in New Zealand, we agree wholeheartedly with Dr Gleeson that Pharmac has been very successful in ensuring New Zealanders have access to medicines at affordable prices.

In fact, a large proportion of the medicines budget is spent on products that many of us could afford to buy ourselves, such as painkillers and antihistamines. It's an unusual bathroom cabinet in New Zealand which is not fully stocked with free or very cheap prescription drugs.

The result is that many New Zealand patients are unable to get the medicines they need to live productive and fulfilling lives. This is not just a pharmaceutical industry suggestion, research published in the New Zealand Medical Journal illustrates the point well (Wonder & Milne, Nov 2011); patients have been receiving access to new medicines at about half the rate of access provided in Australia.

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Importantly, some of the medicines that aren't listed on the pharmaceutical schedule (are unsubsidised) do not have alternatives available locally. Other independent reports have drawn similar conclusions; the country's access to medicine is among the poorest in the developed world. It's true that our expenditure on prescription medicines is a fraction of some other countries', but a nation's health cannot be measured in dollars and cents. Ultimately it is paid for by patients in days off work and family time lost to illness.

The Prime Minister and the Minister of Trade have said repeatedly that New Zealand will not sign up to a free trade agreement that is not in the country's best interests. There has been no suggestion that Pharmac will not retain the right to decide what medicines to purchase and when.

The central issue for the medicines industry within the TPP is simply: What can we do better?

Asking for improvements to how Pharmac operates is not about threatening its existence, but it is about putting health first. We believe that New Zealanders could have access to better medicines if the system was streamlined.

In Pharmac's case, we are asking that it operates in an open and transparent manner, from making a decision within a certain timeframe, to providing clarity about how decisions are made.

This decision-making process has traditionally been closed, with pharmaceutical companies unable to provide input to the clinical committee or answer questions about their products and Pharmac having no obligation to act on recommendations from its clinical advisory committee. The average delay between Medsafe approval of a medicine and Pharmac listing is almost two years, but it can take up to eight years.

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Regardless of what happens in these negotiations, Pharmac will remain long after TPP deliberations are complete.

And, just as we are constantly revising business models, we hope the Government will ensure New Zealanders are getting the best possible outcomes from Pharmac.

There is nothing to fear in having a robust discussion about the best way to deliver the best health outcomes. Improving the system is not about threatening its existence, but about putting health outcomes first.

Kevin Sheehy is general manager of Medicines New Zealand.