Report calls for better access to medicines

While Pharmac decision-making on high-cost, highly specialised medicines could be faster, no new fund should be set up for such drugs.

That view is expressed in the preliminary report on the review of access to such medicines conducted last year by health adviser and GP Dr Paul McCormack, former MP Joy Quigley and University of Otago economist Paul Hansen.

Submissions on the report closed at the end of last month and, while numbers have not been finalised, Dr McCormack said many submitters had broadly supported the panel's preliminary findings.

There was also some useful guidance from submitters which would redirect the final report, due with Health Minister Tony Ryall at the end of the month, he said.

The final report could include a few significantly different recommendations from the initial one, he said.

They would fit in with the Government's general direction of seeking value for money and clinical leadership, and hopefully would remove some of the friction in the present system.

The preliminary report suggests that by improving the medicines system overall, access to high-cost highly specialised medicines will be increased.

The report asks that further attempts be made to encourage a constructive national discussion about ethical issues and funding dilemmas related to high-cost, highly specialised medicines.

Dr McCormack said the Dunedin Hospital situation where a pilot had been suggested to allow public patients to receive unfunded cancer drugs was an important experiment.

If it went ahead, the results would need to be looked at carefully, he said.

The report calls for a single pharmaceutical schedule to cover community, cancer and hospital medicines, and a single scheme to cover exceptional circumstances, to replace the existing three.

Streamlined processes and better communication between Pharmac and others in the sector, especially prescribing and dispensing clinicians, is also sought.

One of the 15 recommendations asks that Medsafe and Pharmac are directed to ensure low-cost and highly specialised medicines are more readily available in New Zealand.

The burden of Medsafe's drug registration processes and costs acted as a major barrier to access to low-cost and highly specialised medicines, the report said.

It cost $80,000 to register a medicine.

This meant it was uneconomic to register a low-cost medicine which would be useful to few patients because it would need to produce revenue of at least $50,000, the panel was told.

The review panel noted that the value for money of medicines received much greater scrutiny than other health technologies.

It would like to see greater efforts to achieve consistency about value for money for medicines and other technologies such as devices, vaccines, medical and surgical procedures and equipment.

Dr McCormack said Pharmac was a success story, allowing New Zealand to punch well above its weight in terms of spending on pharmaceuticals.

The report said political interventions in funding decisions were rare and should remain so.

(The Government decided to offer the 12-month Herceptin treatment to patients with early stage Her-2 positive breast cancer, against the advice of Pharmac.)Dr McCormack said it was understandable that patients faced with diseases with a terrifying impact on their lives or death wanted "a magic bullet, but there are not too many of them around".

Better incentives to reduce wastage of medicines are also called for.

Any such reductions would save money which could be spent not only on high-cost highly specialised medicines, but perhaps also on other medicines and health technologies, the report said.

Medicine
What is considered a high-cost medicine?
A medicine with an annual per-patient cost of $20,000 to $100,000. In future, this could be much more.

What is a highly specialised medicine?
It could be a drug targeted at few patients - fewer than 10 nationally. Or a drug which is technically sophisticated or has something special about its procurement, manufacture or chemical stability. It may not be a high-cost drug.

Source: Review of Access to High-Cost, Highly Specialised Medicines in New Zealand, preliminary report.