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

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PHARMAC propose to post a list of such drugs on their website and clinicians will be advised to check the list before making an application. PHARMAC has recognised that the current Exceptional Circumstances policy contains some very unfair elements. The definition of rare being fewer that 10 patients with the same condition in New Zealand at any one time is simply not able to be managed. PHARMAC have also acknowledged that the application of the criteria has been inconsistent and they have not adequately communicated the reasons for decisions to the claimants. There is also the recognition in the Review document that moral and ethical considerations do play a part in decision making. They argue that there must be fairness between the treatment of claims by individuals, groups of individuals and hospital patients. However, this does not deal with the inherent unfairness of limiting access to patients who suffer very rare diseases and are unique or part of a small group when the greater population has access to drugs under the pharmaceutical schedule simply because they are greater in number. A press release in June 2011 68 by PHARMAC’s Chief Executive indicated that PHARMAC had decided to increase the funding for the old Exceptional Circumstances Scheme (now referred to as the Named Patient Pharmaceutical Assessment scheme) to $8 million per year. In doing so PHARMAC recognised that the current Exceptional Circumstances policy contains elements which were too restrictive for claimants. PHARMAC acknowledged the inadequacies of the current scheme, however they indicated that there is still no purpose an exceptional circumstances scheme could meet which would ensure that all people would be provided all medications which are needed. Section 7: Regularly Occurring Themes from the Data The regularly occurring themes which emerged from the thematic analysis described in Chapter 5 (Research Method) are presented here. 68 http://www.pharmac.govt.nz/2011/06/27/NPPA%20release.pdf 214
Theme 1. Theme 2. Theme 3. Theme 4. Theme 5. PHARMAC has been extraordinarily successful at managing New Zealand’s pharmaceutical budget by providing an adequate supply of quality pharmaceuticals for the lowest cost per drug category in the OECD. PHARMAC’s Community Exceptional Circumstances is a rational way of managing exceptional individual claims, however the decision making criteria have been applied primarily to control PHARMAC budgets. PHARMAC is held accountable to the government through public policy reporting mechanisms, Parliament, the New Zealand Courts and the media. However, PHARMAC has regularly been criticised for not explaining its decisions to Community Exceptional Circumstances claimants and the pharmaceutical industry. PHARMAC does not have a stated philosophical position but operates as a utilitarian agency aiming to provide the highest level of benefit for the greatest number of people. It sometimes does this at the expense of people who have rare conditions or whose needs are considered exceptional. Ministers of Health King and Ryall have both intervened in PHARMAC’s decision making process by directing that selected drugs be made available when PHARMAC had decided against the subsidisation of these drugs. 215
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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
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The drug to treat Pompe’s Disease
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The Voice of Patients and Family Me
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Sclerosis Society did this three ti
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was suffering would not pass the ra
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Eight of the twelve persons approac
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Part II: The Key Informant Intervie
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Page 231 and 232: Chapter 7: Discussion Introduction
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Page 265 and 266: Chapter 8: Conclusions Introduction
Page 267 and 268: Limitations to the Research The ite
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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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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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