本文原文为英文，以下保留原始英文内容。
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.
The decision to review Pharmac should be seen as positive and as good public sector governance, provided the review genuinely aims to modernise a 27-year-old system, improve the way New Zealand accesses publicly funded modern medicines, and enhance the agency’s performance.
Performance for any health service should not be measured by public relations messaging or modelled savings claims. It should be about real health outcomes achieved for patients. Meaningful health outcome measurements would be far more useful than myth-based savings indicators.
Transparency, timeliness, and equity appear to be key themes in the review. Safety of medicines is not, and 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 implications of cost-driven decision-making should still be within scope.
Timeliness of decision-making is a major issue. New Zealand takes about 2.5 times longer than the OECD average of nine months to publicly fund modern medicines, even though those medicines have already undergone rigorous international review. Why the delay? A meaningful review should answer that.
Despite New Zealand’s comparable wealth on a GDP per capita basis, it funds between two and 10 times fewer modern medicines than many OECD peers. That raises an obvious question: is the issue technical rationing or fiscal rationing?
Transparency of decision-making is also a problem. There are internal waiting lists for medicines to be funded within Pharmac, but those lists are not clearly reported. Published records suggest that more than 100 PTAC-recommended medicines had been waiting, on average, almost five years and were still unfunded. If expert advice is sought, why is it not being acted on more effectively?
Equity of access has also been an issue for many years. Around the world, the modern medicines sector often works collaboratively with medicine procurers and other health-sector partners to improve access. That collaborative model has not been adopted as widely in New Zealand, to the detriment of many Maori and Pacific communities.
The wider political problem is that the medicines strategic framework has officially lapsed and the country has never had a written medicines policy like many other OECD nations. That means the Government has neither an active guiding strategy nor a medicines policy from which Pharmac can determine its strategic and operational direction.
Neither the procurement agency nor its enabling legislation are suitable tools for running national medicines strategy or policy. Pharmac is therefore operating like a ship without a rudder, floating within a healthcare system that is itself undergoing major reform.
For that reason, the review should not be a box-ticking exercise that pays lip service to performance, equity, transparency, and timeliness. There is already one recent example showing how modernising systems and working differently can improve access: the whole-of-government Covid-19 vaccine response.
In 2020, the Government took the view that every New Zealander’s health and wellbeing was its top priority during the pandemic. Through the Ministry of Health and MBIE, it secured safe and highly effective vaccines in record time and at relatively low cost by working collaboratively with the medicines industry. That delivered a good outcome for New Zealand and for Pacific states and territories.
The hope is that the Pharmac review is treated as a real opportunity to modernise a system that is no longer fit for purpose and has not kept pace with the rapid change and complexity of innovation in prescription medicines.
This article was originally published as an opinion piece. It is attributed on the original site to Dr Graeme Jarvis of Medicines NZ, representing research-based biopharmaceutical companies operating in New Zealand.