How does the operation of PHARMAC's 'Community Exceptional ...

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extra $180 million this government plans to spend on pharmaceuticals over the next three years. (Scoop, 2008) The decision also applied to patients currently receiving a privately funded course of twelve months Herceptin who had the option of completing the remainder of their treatment funded by a public provider. Patients who had recently completed a publicly funded nine week treatment or recently discontinued a private twelve months course of Herceptin, were able to receive the balance of a twelve month course of treatment publicly funded. However, Ryall made this subsidy subject to the patient’s specialist’s clinical judgment (Scoop, 2008). Section 3: Media Reports This section of data explores the way in which PHARMAC’s Community Exceptional Circumstances policy has been portrayed in the media. Such stories have been presented in the interests of patients, the interests of PHARMAC, the interests of other groups and individuals and also the interests of the media themselves. This study demonstrates the way the public has been exposed to the Community Exceptional Circumstances debated through these media presentations. A library search produced 23 articles from the New Zealand media where the central issue of the article was something to do with PHARMAC’s Community Exceptional Circumstances policy. As described in Chapter 4 (Methods), all the media stories were entered into NVivo 8 as sources. They were then analysed using the Braun and Clark (2006) six step method. I present here only nine of the 23 stories as examples to show the origins and content and voices heard in the stories. I chose these nine stories because each one highlights the range of problems presented about Community Exceptional Circumstances and highlights typical responses from PHARMAC. These examples also demonstrate the range, relevance and impact of the stories. 144
A Selection of the Media Stories Case 1: “Patient’s problem worse on new pills” (New Plymouth Daily News 20/11/98) Brian Coombe and Hawera Rae Mathews (patients) complained that Rae’s symptoms related to her being switched from an unfunded antihypertensive medication to a funded antihypertensive medication. PHARMAC had transferred the subsidy from one drug to another and consequently Rae’s doctor put her on the newly funded medication. She said that the current symptoms she was suffering related to the change in medication. The General Manager of PHARMAC, Wayne McNee had received advice that Rae’s symptoms were not related to the change in medications and said that she could apply for Community Exceptional Circumstances subsidy if she could not tolerate the newly funded drug. The report concentrated on the concern that the preferences of the patient were not considered a factor in the subsidising decisions. McNee reported that many other people in New Zealand were taking the subsidised drug without complaint. Rae was able to draw a response from PHARMAC but she was unable to effect the changes in policy and have PHARMAC’s decision overturned in her case. Case 2: “Persistent seizures curtail life” (Waikato Times 18/10/04) Patient Mike Jurisich requested that PHARMAC pay for an expensive epilepsy drug which was not on the subsidised Community Pharmaceutical Schedule. Verity Colgrave, a case worker from Epilepsy New Zealand, stated in the newspaper report that without the medication Mike would have to cease work and go onto a welfare benefit. She stated that the costs of the patient on a sickness benefit should be considered in PHARMAC’s cost-utility analysis. Mike’s neurologist, Dr. Paul Timmings expressed his frustration at PHARMAC’s Community Exceptional Circumstances decision making, saying that in his experience it was exceptionally difficult to get a Community Exceptional Circumstances claim approved by PHARMAC. There was no evidence produced in the story that the drug recommended by the doctor was any better than the subsidised drug. The media report referred 145
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How does the operation of PHARMAC
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Applying the Test-Questions .......
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Appendix 9: Analysis of Material Re
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List of Abbreviations ABS Australia
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Attestation of Authorship I hereby
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I gratefully acknowledge Major Camp
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Abstract This thesis explores how g
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Chapter 1: Introduction What is thi
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making? Should a person’s level o
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there is no mathematical calculatio
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health, disability, treatment of ol
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I then moved to the subject of rati
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In Chapter 3, New Zealand’s past
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Chapter 2: Background Introduction
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The following journals have no auto
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Technological and pharmaceutical di
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in every sense, and attenuates the
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waiting time for first (or subseque
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Macro-Level Distributions Macro-lev
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(2000) in a report for the Ministry
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level, too many to discuss here. On
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effectiveness of treatment. However
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surgical treatment for ectopic preg
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In a study conducted by the Commonw
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They claim that health inequities c
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these presentations are correct, th
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waiting list for patient priority.
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care within finite resources. The c
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to pay for this co-operation. In 20
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Other results showed that 81% of th
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may be grounds for litigation. Henc
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determine if decisions on the appli
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Chapter 4: Philosophical Framework
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extra person with a good or service
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just actions by individuals. The th
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among the members of the society, a
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example of well off and powerful pe
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necessarily much advantaged over a
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among individuals and communities.
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needs. This was because distinguish
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systematic and transparent. In her
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why PHARMAC would subsidise unecono
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parents refusing treatment for thei
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The first two test-questions covere
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There was no clarity provided by th
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good may be served by their not rec
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Evans (2003) ranked the various typ
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The Use of the Test-Questions in Th
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Qualitative research methods were d
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equirements and considerable politi
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material and by working through the
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and printed copies of Hansard are a
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PHARMAC was criticised in 16 of the
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Page 117 and 118: Table 3: Tree Nodes Used in NVivo A
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Page 123 and 124: DHBs were given the role of funding
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Page 131 and 132: monopolies as such. In their opinio
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Page 203 and 204: Q Do you recall the Kaletra issues
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This was also done for the hard cop
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The Ministry of Health could not lo
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consultation documents which relate
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The following information was recei
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with the application. The discharge
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Again no report was attached from t
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The patient was also prescribed pre
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circumstances described were not su
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treatment was not unusual and the c
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their clinical circumstances would
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Theme 1. Theme 2. Theme 3. Theme 4.
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Chapter 7: Discussion Introduction
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the intellectual property to recove
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The use of QALY’s was tested in t
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Test-Question 2 “Is this distribu
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claimants (and unsuccessful drug co
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(2011-2012) in an open and transpar
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The cost-utility analysis system ha
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Another form of decision making use
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discuss how (or if) PHARMAC meets t
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Test-question 4 also raises the pro
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when there is no profound evidence
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for example value for money, equity
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Community Exceptional Circumstances
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Interferon available to a limited n
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challenges are multiple: to identif
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The data from the research showed h
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PHARMAC could be more open about st
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Chapter 8: Conclusions Introduction
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Limitations to the Research The ite
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There is no one set of indefeasible
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to alcohol and drug treatment or th
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well placed to lead further researc
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utilitarian principles of attemptin
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stand up to the same rigorous clini
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Appendices: Appendix 1: Ethics Appr
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Appendix 2: Key Informant Participa
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Appendix 3: Key Informant Consent F
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Appendix 4: Sample Interview Questi
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Appendix 5: OIA Request Greg Coyle
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Appendix 6: OIA Response from PHARM
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Appendix 7: Community Exceptional C
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Appendix 8: Community Exceptional C
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Ashton, T., & St John, S. (2008). N
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Cohen, G. A. (2008). Rescuing Justi
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Dew, K., Cumming, J., McLeod, D., M
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Glubb, N. (2011). Official Informat
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Holt, S., Harwood, M., Aldington, S
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Lindblom, C. E. (1959). The Science
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http://www.moh.govt.nz/moh.nsf/ea60
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Cash Flows (Ed.), Government of New
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PB/132 National Council of Women of
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Romano, C. (2009). Amartya Sen Shak
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Swedish Parliamentary Priorities Co
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