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

The patient was also prescribed prednisone to manage the inflammation
(presumably in the lung and the joints simultaneously) and this was not
considered a suitable regime to manage the lung disease on a long term basis.
The requested medicine was not registered in New Zealand for this indication.
No supporting journal articles were provided to support the safety or efficacy of
the proposed treatment. No information was provided about rarity or the
unusual circumstances claimed in the application.
The applicants GP or specialist did not indicate why this was an unusual set of
circumstances which would apply in less than 10 cases nationally. The
application simply states that this set of circumstances is “unusual” (Exceptional
Circumstances Panel 2010).
No specialist report or hospital discharge or supporting letter from the GP was
supplied. The Exceptional Circumstances Panel had very little information on
which to consider the criteria for a Community Exceptional Circumstances
claim.
The claim was denied. The GP was informed that the claim did not meet the
criteria for Community Exceptional Circumstances in that the condition was not
rare, the response to alternative treatment was not unusual and the clinical
circumstances described were not sufficiently unusual.
Case No. 6 (OIA Document No. 86) July 2010.
This is an application made by a GP on behalf of a man who has uncontrolled
asthma and was unable to work because of it. The GP was recommending a
Community Exceptional Circumstances subsidy of $834.00 per year for a drug
named Singulair.
The application is made on the grounds of an unusual reaction to alternative
treatments such as Theothlyne, Flixotide, Seravent, Ventolin and Loratadine
and the patient was on a long course of prednisone which was not satisfactory.
None of these medicines have provided relief and the GP believed this to be an
unusual set of circumstances.
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