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

(2011-2012) in an open and transparent way and be accountable for the
distribution of these funds. There is clear evidence that PHARMAC achieves
this objective, notwithstanding the complaints from the pharmaceutical
manufacturing companies who seek to gain access (or greater access) to this
PHARMAC budget.
Test-question 2 then becomes a question not so much whether PHARMAC is
an open and accountable agency, but how open is PHARMAC and how
accountable is it? Papers uncovered through the use of the OIA and the Walsh
vs PHARMAC judgment, show that whilst PHARMAC has legally valid policies
and procedures it does not always follow them. The New Zealand AIDS
Foundation submitted that they do not make ‘Community Exceptional
Circumstances’ claims or engage in public consultation and debate in order to
obtain subsidies for the drugs which are needed to treat AIDS in New Zealand.
This is because so few cases are decided positively and the outcomes are so
uncertain. Rasiah’s (2009) research into ‘Community Exceptional
Circumstances’ claims confirmed this point.
The decisions made by the Community Exceptional Circumstances Panel do
have an impact on the Community Exceptional Circumstances budget and
ultimately, PHARMAC’s total budget. My research has shown that the decision
making panels on occasions have decided that claimants have met the criteria
for a Community Exceptional Circumstances subsidy, but the claim has been
be denied because of the fiscal impact of the decision.
The claim made by Alison Locke, who suffered from Pompe’s Disease, was a
case in point. Her claim for medicines met all the Community Exceptional
Circumstances criteria, except the most important one; PHARMAC’s
affordability criteria. This was due to the high QALY cost of the drugs Locke
needed to extend her life. The QALY calculation demonstrated that PHARMAC
could not fund the medicines in subsequent years.
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