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

No we have never thought that $3 million is not enough…I mean we
have managed pretty well on that. (Interviewee B)
‘B’ described the problem for PHARMAC where they provide a Community
Exceptional Circumstances claim for a subsidy for a particular condition which
met the funding criteria and then doctors began to diagnose this problem more
regularly. Then the medical condition actually became more common and was
no longer rare. This substantiated a claim that the drug should be placed on the
general pharmaceutical schedules. This indicated that Community Exceptional
Circumstances claims were a route for getting a drug noticed and then funded
on one of the pharmaceutical schedules.
With something that is actually stunningly rare…the condition often
becomes more common. I don’t mean doctors are playing games or
anything like that but…when something rare is diagnosed and we
fund it under EC [Community Exceptional Circumstances]…it
becomes something that people become aware of and other
examples of the rare condition just turn up. There are some good
examples of this: Pulmonary coronary hypertension is a good
example…where doctors are finding that they are able to diagnose it
much more readily and then it no longer becomes a rare condition,
so yes it does go onto the schedule…eventually. (Interviewee B)
Interviewee ‘C’: “I am not equipped to worry too much about the fairness to this
one or the fairness to that one”.
The format for reporting this interview is slightly different to the other interviews
presented. This is because the questions which were put to interviewee ‘C’
were particularly insightful in informing the content of the answers. The
questions in the other interviews were conversation starters. I felt that both the
questions and flow of conversation which Interviewee “C” were necessary to
report.
These questions are identified as Q in the text and the answers are identified as
A in the following text. This system is used in subsequent interviewers as well.
Interviewee ‘C’ was had a long experience of deciding on Community
Exceptional Circumstances claims. ‘C’ confirmed this in the interview.
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