NZORD Newsletter 2008 #1 - 24 January 2008

Hello everyone,

In this single issue newsletter, some more analysis of the medicines strategy announced in December 2007:

Medicines Strategy signals significant changes.

A good result from years of lobbying on medicine access issues, but a lot more work to do.

The government's strategy announcement Medicines New Zealand and the accompanying plan for Actioning Medicines New Zealand were greeted with disappointment by most stakeholders at the lack of immediate action to fix the most pressing issue - a serious underfunding of medicines for New Zealand patients. But time to reflect on the details of the strategy and action plan gives a far more satisfying read and cause for optimism about the future.

In the strategy government has delivered a mix of major and subtle changes to the system, all adding up to a significant change of direction:

  • Pharmac's wings have been significantly clipped.
  • Patient access to affordable medicines is now a strategic outcome.
  • Equity and affordability for patients are elevated to major principles that will guide decisions, and given equal standing to cost effectiveness considerations.
  • Protection from substantial financial costs due to ill health is noted as an overarching health system outcome.
  • Steps will be taken to protect patients from negative consequences of changes to subsidised brands.
  • Detailed reviews will examine exceptional circumstances provisions and specialist-only prescribing rules.
  • Greater consultation and feedback processes are mandated.
  • There will be more transparency in budget setting and District Health Boards will be more accountable for their roles in this.
  • Reviews will ensure the independence of PTAC's technical advice to Pharmac, and examine the role of the Consumer Advisory Committee.

NZORD expects there will be much improved outcomes in the medium term as this strategy beds down, provided there is commitment to its implementation. District Health Boards and Pharmac will work to a principles-based approach to setting the overall budget. If properly applied, this should see improvements in total funding available, though we are sure that a government intervention is still needed to correct the chronic underspend on medicines.

Of particular interest is the rejection of Pharmac's proposed approach to decisions about high cost therapies. Pharmac submitted a detailed paper on this topic to the Ministry consultation, essentially arguing no special consideration for high cost medicines, and a wish to rely on basic cost-utility criteria, but there is no support for their proposals at all in the strategy or action plan. In fact the Pharmac approach to high cost therapies is contradicted, by implication, by the specific inclusion of references to equity, access, affordability, and protection against substantial financial costs. Commentary in the accompanying papers to such things as "ensuring that new Zealanders can get access to the medicines they need" and "taking account of and reflecting community values", further rejects Pharmac's crude utilitarian approach and incorporates the themes we proposed. This seems to be a significant victory for the submissions we made specifically challenging Pharmac's papers on high cost medicines.

Those of us involved in many months and years of detailed work to achieve this strategy, should feel very pleased with the strategy produced by government. It must have been very tempting for government to let their direct financial interest in containing costs, prevail as the guiding themes in their strategy. That, after all, is what we have had for the last decade and a half - a narrow cost containment approach by all the governments throughout that time. Instead the government has risen to the challenge we put to them in our submissions via the Access to Medicines Coalition, and set a visionary medicines strategy that strongly incorporates patient interests and community values, at last. The government's response is most welcome.

A major implication of the way the strategy and action plan are set out, is the need for a lot of ongoing work by support groups and other stakeholders to participate in the reviews and consultation processes. Ensuring things work the way intended will require probably as much work over the next few years as was put into achieving the new strategy. Changes occurring with new faces on the board of Pharmac and changes pending in Pharmac management also signal work required to develop the relationships and communications needed to ensure things go as planned.

Support group involvement will need to change too as we adapt to a more open and transparent model for decision-making about medicines. We have more recognition as stakeholders in the strategy and we have roles to fill. We will need to be less reactive and more engaged in the whole process and seek out opportunities for us to take initiatives in a more accountable and more patient friendly system. The strategy and action plan can be found on the Ministry of Health website.

It is an absolute delight to be able to write such a positive newsletter. Such opportunities are few and far between.

Regards, John

John Forman
Executive Director, NZORD