The review will look at how Pharmac performs against its current objectives and whether it could do a better job for New Zealanders if the Government set new objectives.
OPINION: The governments of many developed nations fund medicines for their citizens after they have gone through independent expert technical, clinical and health economic analyses. New Zealand is neither unique in this regard, nor different or better. Its only point of difference is a capped medicines budget mandated under enabling legislation.
That this Government has decided to have a review into Pharmac should be seen as positive by the country, and good public sector governance. This assumes, of course, that the review truly aims to look at ways to modernise a 27-year-old system and both to improve the way New Zealand accesses publicly funded modern medicines and to enhance the agency’s performance.
Performance for any health service should not be about PR, such as modelled graphs reporting assumed, rather than actual, savings. It should be about health outcomes achieved. Hopefully, the review can lead to the generation of meaningful health outcome measurements for patients, not myth-based savings indicators.
Transparency, timeliness and equity seem to be key areas of focus in the review. Safety of medicines is not – that is rightly a statutory role for Medsafe, not Pharmac. However, given recent deaths following an enforced brand switch of an epilepsy drug, now subject to a coronial investigation, the safety of Pharmac’s cost-driven decision-making processes should be within scope.
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Timeliness of decision-making is an issue. New Zealand takes 2.5 times as long as the OECD average of nine months to publicly fund modern medicines, all of which have undergone rigorous review internationally, including assessment of clinical need and effectiveness. Why the delay? Hopefully the review will answer this question.
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Despite New Zealand’s comparable wealth on a GDP per capita basis, it funds between two and 10 times fewer modern medicines than our OECD peers. Why the disparity? Is it technical or fiscal rationing? Only the former is considered in-scope for the review.
Transparency of decision-making is also a problem. There are internal waiting lists for medicines to be funded within Pharmac – but these lists are not transparently reported. This needs to be addressed.
The only list that can be generated from published records of Pharmac’s Pharmacology & Therapeutics Advisory Committee (PTAC) makes for dire reading. A total of 110 PTAC-recommended medicines have been waiting on average almost five years on the list, and are still to be funded. Why have experts advise on medicines if the advice is not being heeded? Perhaps the review will answer that question.
Equity of access has been an issue for many years. Globally, the modern medicines sector works with medicine procurers and other partners in the health sector to optimise this. This collaborative model has not been as widely adopted in New Zealand – to the detriment of many Māori and Pacific Islanders. The review needs to explore the reasons for this.
The proposed intent and focus of the review, however, misses the political pachyderm in the room. The medicines “strategic framework” has officially lapsed and the country has never had a written medicines policy, unlike other OECD nations. So the Government has neither an active guiding strategy nor a medicines policy from which Pharmac can determine its strategic and operational directions.
Neither the procurement agency nor its enabling legislation are suitable tools through which to be running medicines strategy or policy. The DHB funding model, from which the medicines budget is obtained, is also about to be significantly modified.
Pharmac is therefore like a ship without a rudder – floating in the stormy seas of a healthcare system undergoing its own reform.
For that reason, it’s important that the review is not just a box-ticking exercise that pays lip service to performance, equity, transparency and timeliness.
There is one excellent recent example showing how modernising and doing things differently improves timeliness of access – namely the whole-of-government Covid-19 vaccine response.
The Government took the position in 2020 that every New Zealander’s health and wellbeing was its No 1 priority during the pandemic. As a result, it has, via the Ministry of Health and MBIE, obtained safe and highly effective vaccines both in record time and at a low cost, by working collaboratively with the medicines industry. A good outcome for New Zealand, and its Pacific states and territory too.
The hope is that this Government truly sees the Pharmac review as an opportunity to modernise a 27-year-old system that is not fit-for purpose and has not kept up with the rapid change in the development and complexity of innovation in prescription medicines.
For its part, the medicines industry will be an engaged and willing stakeholder in any open, transparent review process that leads to better health and wellbeing outcomes.
* Dr Graeme Jarvis is chief executive of Medicines NZ, the industry association representing research-based biopharmaceutical companies operating in New Zealand. It advocates for the benefits of modern medicines as part of a high-quality public health system, but does not fund any patient groups or government entities.