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

No information was provided on the application form about the rarity, reaction to
alternative treatment or unusual combination of circumstances of the case. No
articles were provided to prove safety or clinical benefit. No specialist report
was provided to the Community Exceptional Circumstances Panel on the case.
Only a note to the patient’s GP relating to a recent out-patient’s consultation
was provided. No mention was made of any difficulty managing the patient or
unusual circumstances which were prevailing. No mention was made in the
note of the need to apply to PHARMAC for a Community Exceptional
Circumstances subsidy. The only mention was the following comment to the
GP: “Mum says she does have some problems giving him the indomethacin and
there also has been a problem with supply more recently” (Exceptional
Circumstances Panel 2010).
This comment indicated that the patient had already been prescribed the drug
and the information supplied in the application suggested that this process was
constructed to approve a subsidy for the medicine despite the application
criteria and requirements not being met.
The application was successful and the patient was notified through GP. The
Panel did not give any reasons in the letter as to why the application was
approved.
Case No. 5 (OIA Document No. 86) July 2010.
This was a case of a GP making a claim to the Community Exceptional
Circumstances Panel on behalf of a woman who was suffering interstitial lung
disease with a pneumonitis believed to be induced by taking the drug
Lefluromide. The 3 month initial application was made for a drug named n-
acetyl cystine at a cost of $412.00 for 100 tablets. The application noted that
this drug could be sourced through a company named Life Extension Pacific Ltd
for US$ 21.50 for 60 tablets.
The application was made under the criterion of unusual combination of clinical
circumstances. These circumstances were that the patient had developed rare
side effects of pneumonitis as a result of taking Lefluromide and Methotrexate
together whilst trying to manage her rheumatoid arthritis.
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