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

supporting them and his wife also has breast cancer. What is the
difference? There is no difference…there is no difference.
(Interviewee B)
When ‘B’ was asked if PHARMAC always sticks to the criteria for Community
Exceptional Circumstances when deciding a claim, ‘B’ admitted that on
occasions PHARMAC uses the policy as a mechanism for solving a problem.
‘B’ gave the example where Community Exceptional Circumstances subsidy
was granted to a lot more than 10 patients with the same problem. In these
cases, PHARMAC was not sure if there are enough patients to subsidise the
drug on the schedule. Also ‘B’ explained that when there were some patients
where the costs of treatment are extraordinarily high, and there are a low
number of patients, drug companies will not take up a contract because the
numbers are so low in New Zealand. In these instances, PHARMAC
sometimes used Community Exceptional Circumstances subsidy to fund the
drug.
On occasions, the EC scheme is used as a mechanism to fund
something where there is a pressing need but no other way of doing
it. Liothyoronine 54 is an example of this. (Interviewee B)
‘B’ stated that PHARMAC used the Community Exceptional Circumstances
policy more as a cost containing strategy and not strictly a mechanism for
ascertaining if an individual should be funded for a medicine which is outside
the pharmaceutical schedule. The criteria were used by the Community
Exceptional Circumstances Panel to assess each claim. Decisions are based
on the panel members’ knowledge of the medical condition, rarity and the
evidence of cost-effectiveness of the proposed treatment. Cost containment is
not stated as a criterion. However, the way ‘B’ described the management of
the Community Exceptional Circumstances, policy; it has been used as an
effective cost containment policy.
54 Liothyoronine is the most potent form of thyroid hormone which regulates protein, fat, and carbohydrate metabolism.
It acts on the body to increase the metabolic rate, the synthesis of proteins and increases the body's sensitivity to
adrenaline. See http://en.wikipedia.org/wiki/Liothyronine_sodium
166