The Trans Pacific Partnership (TPP) has provided an opportunity to benchmark the New Zealand medicines procurement system with its international peers.
Over time, people around the world have increasingly benefitted from major improvements in life expectancy and quality, in part due to huge leaps forward in the benefits offered by new medicines. New Zealanders have also experienced many of these benefits and medicines are a cornerstone of all modern health systems.
New Zealand is unusual in how it makes decisions about what medicines to purchase. The main points of difference are however, not that it uses cost effectiveness as a decision criteria, but issues such as the lack of transparency, timeliness and independent clinical advice. When making a decision that is truly based on evidence, there is no need to avoid a healthy and open scientific debate. In fact one of the foundations of scientific evidence is that it should be open to scrutiny and review.
The medicines industry recognises that PHARMAC has been successful in providing equal access to medicines for people, but equality of access does not need to come at the expense of access to improved medicines. There are a number of people who do not get access to the most effective treatment for their conditions, and because the decisions about this access are made in a black box, the public cannot know if they are the best possible decisions.
Public debate can only be meaningful when the information on which it relies is available and this is essentially the basis of the changes suggested by the medicines industry in the TPP negotiations currently being carried out between NZ and the US and other Pacific nations.
The improvements being recommended to the PHARMAC system are:
Timelines - decisions should be made within a predetermined timeframe
Transparency - the scientific information on which decisions are based should be shared transparently between PHARMAC and applicants
Decisions - the system should require PHARMAC to make a decision and communicate this decision to stakeholders
Decision criteria - these should be applied transparently and consistently
Stakeholder access - stakeholders should have meaningful opportunity to provide input to the decision process at the appropriate stages
Targeting pharmaceuticals - pharmaceutical products should not be treated differently to other health technologies in the procurement process
Value attributed to innovative treatments - where innovative treatments demonstrate improved patient outcomes these should be appropriately valued by the procurement system.
The improvements sought are strongly aligned with the recent report to Cabinet on the consultation with clinicians about the role of PHARMAC being expanded into funding hospital medicines collated by Dr David Sage of the Auckland DHB.
After 17 years of a heavily restrained medicines investment and a seemingly exclusive focus on cost saving there are areas where we have not kept up with international best practice, as confirmed by a recent literature article showing New Zealand achieves access to medicines at approximately half the rate that Australia does. There are also differences between the medicines used in NZ and those recommended by some of the internationally accepted treatment guidelines.
We believe that the improvements discussed here provide an opportunity for a win-win situation between improved patient access to medicines and a robust Health Technology Assessment (HTA) based funding process.