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

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myocardial damage. It is believed that oral morphine substitute (methadone) is the cause of the Q-T prolongation. The woman had been diverting this drug by injecting the medicine intravenously and not taking it orally. Her specialist noted that the she was at risk of septicaemia and endocarditis if she continued on methadone, particularly injecting it intravenously. The patient requested that she be given more methadone treatment however the specialist believed this would be contraindicated. The patient’s doctor made a Community Exceptional Circumstances claim for a drug named Suboxone. This is a home-based treatment of narcotic medication indicated for the treatment of opioid dependence and an alternative medicine to methadone. The cost of the treatment was anticipated to be between $3,790 and $5,685 annually and the claim was for an indefinite period. This claim was approved because it met the second criteria (criteria [b]) on the application form which states a ‘reaction to alternative treatment unusual (unusual is considered
with the application. The discharge summary provided by the hospital was supplied instead. Despite the required process not being followed in this case, the Community Exceptional Circumstances Committee approved the application. There are no reasons given or any determination about the criteria under which the claim was approved. The letter to the applicant simply states that “application for supplies of [Suboxone] …have been approved …based on the information you supplied” (Exceptional Circumstances Panel 2010). The application was successful and the patient was notified through her GP. Case No. 2 (OIA Document No. 82) May 2010. This application for Community Exceptional Circumstances subsidy was for a patient with long-standing Lupus Erythematosus, a chronic auto-immune disease. She had been treated with hydroxyethyl quinine, prednisone and topical steroid ointments. These treatments were apparently not as effective as a one month course of chloroquinine. The patient reported that she had been in the best health she could remember in the last 10 years on the trial of chloroquinine. The anticipated cost of the drug was $710.00 per year. The specialist did not specify on the application form under which criteria the application was being made. The doctor attempted to establish that this was a rare condition by writing on the application form “only 2 cases I have treated” (Exceptional Circumstances Panel 2010). However the Lupus Care and Support New Zealand 65 organisation identifies that this condition is suffered by one or two people in every 1,000 New Zealanders. Consequently, there are between 4,000 and 6,000 sufferers with lupus in New Zealand and there were clearly more than 10 sufferers with this condition in New Zealand at the time of the application. No articles were provided with the application to prove that the requested drug was safe. Neither was supporting data about the effectiveness of the alternate treatment supplied. There were two specialist letters to the patient’s GP provided with the application and no report from the specialist to PHARMAC 65 Website (http://www.lupussupport.org.nz/index.html ) 203
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How does the operation of PHARMAC
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Applying the Test-Questions .......
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Appendix 9: Analysis of Material Re
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List of Abbreviations ABS Australia
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Attestation of Authorship I hereby
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I gratefully acknowledge Major Camp
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Abstract This thesis explores how g
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Chapter 1: Introduction What is thi
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making? Should a person’s level o
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there is no mathematical calculatio
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health, disability, treatment of ol
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I then moved to the subject of rati
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In Chapter 3, New Zealand’s past
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Chapter 2: Background Introduction
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The following journals have no auto
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Technological and pharmaceutical di
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in every sense, and attenuates the
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waiting time for first (or subseque
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Macro-Level Distributions Macro-lev
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(2000) in a report for the Ministry
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level, too many to discuss here. On
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effectiveness of treatment. However
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surgical treatment for ectopic preg
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In a study conducted by the Commonw
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They claim that health inequities c
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these presentations are correct, th
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waiting list for patient priority.
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care within finite resources. The c
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to pay for this co-operation. In 20
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Other results showed that 81% of th
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may be grounds for litigation. Henc
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determine if decisions on the appli
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Chapter 4: Philosophical Framework
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extra person with a good or service
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just actions by individuals. The th
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among the members of the society, a
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example of well off and powerful pe
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necessarily much advantaged over a
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among individuals and communities.
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needs. This was because distinguish
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systematic and transparent. In her
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why PHARMAC would subsidise unecono
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parents refusing treatment for thei
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The first two test-questions covere
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There was no clarity provided by th
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good may be served by their not rec
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Evans (2003) ranked the various typ
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The Use of the Test-Questions in Th
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Qualitative research methods were d
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equirements and considerable politi
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material and by working through the
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and printed copies of Hansard are a
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PHARMAC was criticised in 16 of the
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I tried to find an interviewee from
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The flow of discussion in the inter
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that the disclosure is commercially
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6. Producing the report The final o
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The following tables outline the no
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Table 3: Tree Nodes Used in NVivo A
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At this point, I stopped using NViv
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Chapter 6: Research Findings Introd
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DHBs were given the role of funding
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These measures were in response to
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Table 5: The Submitters to the Heal
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towards New Zealand and for them to
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monopolies as such. In their opinio
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for the delivery of such services (
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NCWNZ that S42(a) of the Bill, requ
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contentious among Maori Iwi. Any Ma
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Dugdale further advised that if non
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cumbersome and recommended that PHA
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following text, I have individually
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Herceptin. The plaintiffs forwarded
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the treatment of cancer in the DHB
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eligible people in New Zealand and
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confirmation that the DHB hospital
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the eight women involved in this ca
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the plaintiffs adequate opportunity
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Judge’s Concluding Remarks The fi
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A Selection of the Media Stories Ca
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Case 4: “Worn out by endless figh
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Case 6: “PHARMAC scolded for MS-d
Page 165 and 166: The drug to treat Pompe’s Disease
Page 167 and 168: The Voice of Patients and Family Me
Page 169 and 170: Sclerosis Society did this three ti
Page 171 and 172: was suffering would not pass the ra
Page 173 and 174: Eight of the twelve persons approac
Page 175 and 176: Part II: The Key Informant Intervie
Page 177 and 178: agreed this was done. Secondly, PHA
Page 179 and 180: the pharmaceutical schedule. The or
Page 181 and 182: No we have never thought that $3 mi
Page 183 and 184: Insights were given as to the indep
Page 185 and 186: and Now some people can say that’
Page 187 and 188: Q Be a voice for the family? A Yes,
Page 189 and 190: key issue here. Some clinicians wer
Page 191 and 192: I deeply suspect that Community Exc
Page 193 and 194: should be developing the capacity o
Page 195 and 196: make. And so PHARMAC has been a hug
Page 197 and 198: and PHARMAC is not above rationing
Page 199 and 200: This case demonstrated that the cos
Page 201 and 202: and budget management. It says this
Page 203 and 204: Q Do you recall the Kaletra issues
Page 205 and 206: Q Can I ask you about PHARMAC’s c
Page 207 and 208: ….successfully…for things espec
Page 209 and 210: This was also done for the hard cop
Page 211 and 212: The Ministry of Health could not lo
Page 213 and 214: consultation documents which relate
Page 215: The following information was recei
Page 219 and 220: Again no report was attached from t
Page 221 and 222: The patient was also prescribed pre
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Page 225 and 226: treatment was not unusual and the c
Page 227 and 228: their clinical circumstances would
Page 229 and 230: Theme 1. Theme 2. Theme 3. Theme 4.
Page 231 and 232: Chapter 7: Discussion Introduction
Page 233 and 234: the intellectual property to recove
Page 235 and 236: The use of QALY’s was tested in t
Page 237 and 238: Test-Question 2 “Is this distribu
Page 239 and 240: claimants (and unsuccessful drug co
Page 241 and 242: (2011-2012) in an open and transpar
Page 243 and 244: The cost-utility analysis system ha
Page 245 and 246: Another form of decision making use
Page 247 and 248: discuss how (or if) PHARMAC meets t
Page 249 and 250: Test-question 4 also raises the pro
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Page 253 and 254: for example value for money, equity
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Page 257 and 258: Interferon available to a limited n
Page 259 and 260: challenges are multiple: to identif
Page 261 and 262: The data from the research showed h
Page 263 and 264: PHARMAC could be more open about st
Page 265 and 266: Chapter 8: Conclusions Introduction
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Limitations to the Research The ite
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There is no one set of indefeasible
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to alcohol and drug treatment or th
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well placed to lead further researc
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utilitarian principles of attemptin
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stand up to the same rigorous clini
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Appendices: Appendix 1: Ethics Appr
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Appendix 2: Key Informant Participa
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Appendix 3: Key Informant Consent F
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Appendix 4: Sample Interview Questi
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Appendix 5: OIA Request Greg Coyle
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Appendix 6: OIA Response from PHARM
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Appendix 7: Community Exceptional C
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279
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Appendix 8: Community Exceptional C
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Ashton, T., & St John, S. (2008). N
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Cohen, G. A. (2008). Rescuing Justi
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Dew, K., Cumming, J., McLeod, D., M
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Glubb, N. (2011). Official Informat
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Holt, S., Harwood, M., Aldington, S
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Lindblom, C. E. (1959). The Science
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http://www.moh.govt.nz/moh.nsf/ea60
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Cash Flows (Ed.), Government of New
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PB/132 National Council of Women of
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Romano, C. (2009). Amartya Sen Shak
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Swedish Parliamentary Priorities Co
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