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

Q So you think this definition is fair on the patients? What about
someone who is 11 th or 21 st ? Is it fair for them too?
A Well yes and no. Yes, it is fair to the ones that get it...and I suppose
no, the definition is not fair on the ones we say no to. It is fair on the
whole…PHARMAC has to deal with the whole PHARMAC budget...I
suppose it is fair on the rest of society…if you look at it like that.
When ‘C’ was taken back to the answer given about the definition of fairness
earlier in the interview being “a consistent process where everybody is treated
the same way and has the same capacity to get the same sort of things, s/he
made the most telling remark:
Well when it comes to Exceptional Circumstance, look I am just not
equipped to worry too much about the fairness to this one or the
fairness to that one…no my expertise is in medical things… that is
really the advice I was giving PHARMAC…medical advice
(Interviewee C).
Interviewee ‘D’: “Some clinicians were very good at using the system and
others just didn’t take the time to use it”.
Interviewee ‘D’ was a past or present manager of Exceptional Circumstance
claims with considerable experience handling the PHARMAC process. ‘D’ was
responsible for the communication between PHARMAC and the claimant
families and communication with the Medical Advisor and the Exceptional
Circumstances Panel.
In the discussion, ‘D’ stated that there were two masters to be served in the
Community Exceptional Circumstances area. The first master was advocacy on
behalf of the patient. The second master as far as ‘D’ was concerned was a
clear agenda to manage political risk on behalf of PHARMAC.
Q How did you see your role at PHARMAC?
A My role was to co-ordinate the process basically, and again be a
voice for the patient or the family and clinician submitting the
application.
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