Pharmac changes funding processes for greater transparency

Wiki Mulholland, who has advanced breast cancer, speaks to the health select committee earlier this year. Photo / Mark Mitchell

Government drug-buying agency Pharmac will remove a load of applications for drug funding from its waiting list because it is unlikely to ever approve them.

Pharmac's chief executive Sarah Fitt said the move, as part of an overhaul of its decision-making process, would give a better insight into what medicines were and were not being actively considered for funding.

Pharmac was proposing to decline a number of funding applications that were sitting open in the application system but unlikely to ever be funded.

"We have open applications for medicines with little or no evidence that they work better than other medicines, with proof that they could cause people harm, or with no company able to supply the medicine in New Zealand," Fitt said.

"Unfortunately, we'll never be able to fund everything, and we can't justify using taxpayers' money to fund medicines that aren't better than treatments we already fund.

"We've heard from New Zealanders that they want Pharmac to make definitive decisions on funding applications, so they can have some certainty, even if this is a decision to decline funding."

Pharmac wants other changes to increase transparency and reduce the time medicines spent on the waiting list, including making its online application tracker easier to understand and publishing summaries of clinical experts' advice and recommendations faster.

Pharmac was seeking public feedback on the first group of eight applications it was proposing to decline and would not make a final decision until it had been considered.

"Feedback from this consultation will help us make decisions on the eight medicines and it will also help us determine if our consultation approach works for people who are interested in and want to contribute to our decision-making," Fitt said.

A decline now would not stop any future application should new evidence emerge later that warranted the drugs being funded.

Health Minister David Clark said he was pleased Pharmac was fulfilling his request to make their processes more transparent, which he outlined in a recent letter.

Pharmac and its funding processes have been in the spotlight recently, with a petition presented to Parliament calling for an inquiry into its outdated methods.

The health select committee has voted against holding its own inquiry into Pharmac but has not ruled out asking for an independent review.

The committee has in recent months been hearing from women with advanced breast cancer who are seeking funding for two drugs, Ibrance and Kadcyla, which they say could prolong their lives.

The applications have been in train for a number of years and Pharmac's committee of oncology experts are yet to recommend whether they should be fully funded. That decision is due early in May.

The Breast Cancer Aotearoa Coalition last week said Pharmac had refused funding for Kadcyla after it received information from Roche, the drug company behind the application.

Pharmac reiterated then that no decision had been made on Kadcyla.

More than 600 Kiwi women die each year from breast cancer, the nation's third most common form of cancer.

A day of action at Parliament is planned for May 7, when eight petitions signed by more than 17,000 people will be presented to MPs, asking for 26 drugs be funded for six diseases.

Supporters of groups including the Lung Foundation New Zealand, Breast Cancer Aotearoa Coalition, Ovarian Cancer New Zealand, Myeloma New Zealand, Pompe New Zealand and Chronic Lymphocytic Leukaemia Advocates New Zealand will march to Parliament to hand over the petitions.

Clark said he was unsure at this stage whether he would receive the petitions on May 7.

Pharmac is proposing to decline funding applications for:
• Cisapride for gastrointestinal motility disorders
• Melatonin for people with insomnia aged 55 and above, and for people with insomnia secondary to dementia
• Methylphenidate for depression in terminally ill people and for people that are treatment resistant, and traumatic brain injury
• Paracetamol sustained release tablets
• Sibutramine for obesity
• Simeprevir for chronic hepatitis C, genotype 1
• Temozolomide for glioma (brain tumour)
• Trastuzumab for HER2 positive metastatic gastric cancer

The issue of Pharmac

Pharmac is a government agency with a budget of close to $1 billion a year.

It decides which pharmaceuticals will be publicly funded in New Zealand and is responsible for all community and DHB spending on medicines and medical devices.

Critics say its processes are outdated and take too long, and have called for an independent inquiry.

The health select committee has ruled out its own inquiry but chairwoman Labour MP Louisa Wall says there may be an independent review.

At present, pressure is being applied to Pharmac and the Government by drug companies and patients for funding for two drugs, Kadcyla and Ibrance, to be fully funded for women with advanced breast cancer.

Pharmac has not yet made a decision and is awaiting the minutes of its expert committee due early next month before deciding.

Another eight petitions calling for Pharmac funding for other drugs will go to MPs next week after a march to Parliament.