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

Dr. Hamilton, Nicholas’s oncologist, described how he agonised over the ethical
decision of whether to tell the Mickeljohns about the new drug or not. It was not
available on the pharmaceutical schedule because of the high cost and the
minimal benefit in prolonging life for an uncertain period. He commented that
the drug would not provide a cure for Nicholas but only an uncertain few
“percentage gains”. He said that New Zealand is reasonably well served by
subsidised drugs, most are funded and it is very difficult to place a price on
extending life.
Wayne McNee, PHARMAC’s General Manager was sympathetic to Nicholas’s
plight but could not recommend the drug be provided under Community
Exceptional Circumstances because his condition is not rare. McNee said that
a formula exists to help decision making and these cases. The decisions were
becoming increasingly more difficult because drugs were becoming more
expensive. He commented that cancer drugs in 2003 cost New Zealand $22
million and by 2006 the cost had risen to $41 million. He also noted Temodal
has been referred to the CaTSoP, a committee of PTAC, to decide if it would be
funded. McNee also stated that “it is a sad fact you have a good chance of
getting expensive, life-saving treatment if you’re injured in a car crash, and not if
you have a degenerative disease.”
Wayne McNee was referring to the different funding mechanisms between
treatment for accident victims by the Accident Compensation Corporation
(ACC) 49 and non-accident victims being treated by DHBs.
McNee noted that there is a limitation on the availability of publicly funded
treatment and as in cases where new and expensive experimental drugs in
cancer treatment were prescribed before a subsidy was granted, the patient
must fund their own treatment. He stated that, to those who cannot afford to
self-fund experimental medications, this situation seems grossly unfair.
49 Accident Compensation Corporation is a New Zealand social health insurance which is funded by taxpayers and road
users. It is a ‘no fault’ health insurance scheme where all claims which are proven to meet the definition of ‘personal
injury by accident’ are accepted and almost all the medical, surgical and other costs of the injured person’s rehabilitation
are met by the Corporation. New Zealanders do not have the right to take litigation action against persons or institutions
which they believe are responsible for their injury. The access to treatment under the ACC is considered quicker and
more comprehensive than under the normal sickness treatment provided through the DHBs.
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