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

Part II: The Key Informant Interviews
The purpose of presenting raw text here is to allow the interviewees to do the
talking. Readers will hear the opinions expressed by the interviewees on the
various subjects discussed and will be able to discern the tone of the interviews
and in some cases the depth of feelings and commitment of the interviewees to
getting their story told.
Interviewee ‘A’: “If there aren’t any constraints then everybody will become
exceptional”
Interviewee A was a past or present senior manager of PHARMAC. ‘A’
described the Community Exceptional Circumstances policy as a way of dealing
with individuals who needed or wanted a subsidy for medicines that were not on
the Community, Cancer or Hospital Pharmaceutical Schedules. ‘A’ described
the claims as coming from people who didn’t fit the standard schedule of
subsidies. Primarily, ‘A’ saw the Community Exceptional Circumstances policy
as a resource allocation mechanism with quite specific criteria around it,
however did concede that the rarity criterion was not strictly adhered to by
PHARMAC.
This method [Community Exceptional Circumstances] was used for
allocation of relatively high costs of medicines for rather a few
numbers of individuals. The numbers became a marginal call. It
might be that we would provide a drug for the 10 people, it might be a
hundred people, it may be 300 people. It’s not so much that we were
thinking about it in relation to the taxpayer, because this works
largely in relation to the amount of money available, so we were
trying to think about, well, how you provide a greater overall benefit
to a larger number of people. (Interviewee A)
When asked how PHARMAC decided that rare meant less than 10 cases of any
particular condition at any one time in New Zealand, ‘A’ referred to the fact that
PHARMAC did not invent the definition but inherited the definition from the
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