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

discuss how (or if) PHARMAC meets the needs of those who are described as
exceptional.
Starting with PHARMAC’s first purpose, as a Crown Entity it must provide
access to the public for an adequate range of affordable pharmaceuticals. This
focuses on the PHARMAC Board and staff having a system of identifying which
medicines will meet the clinical needs of New Zealanders. This is done by
PHARMAC operating an analytical system for deciding how to effectively meet
these needs. Singer and colleagues (Singer, Martin, Giacomini, & Purdy, 2000)
stated that the first step in deciding what should be done to make such
decisions legitimate and fair, is to understand how groups such as PHARMAC
make these allocative decisions.
At the meso-level, PHARMAC is required to implement the government’s stated
health strategies. PHARMAC has at its disposal the District Accountability
Plans which are conducted by the 21 DHBs. PHARMAC also has access to the
knowledge and experience of expert committees of medical specialists who are
recognised as leading practitioners and academics in their clinical fields. They
make assessments of the clinical effectiveness of medicines based on
internationally available research and their own clinical judgment. To not do so,
opens PHARMAC up to the possibility of spending tax payers’ money on
ineffectual treatments that only promise to add to a person’s capability (Moodie,
2008). PHARMAC’s approach comes down to quantifiable evidence of likely
benefit verses a promise of benefit.
This is little comfort however to unsuccessful Community Exceptional
Circumstances claimants whose applications have been ruled either unlikely to
provide significant clinical benefit, or, medicines which come at too high a cost.
At the micro-level, having decided on the effectiveness of meeting particular
health needs with pharmaceuticals, PHARMAC then engages in the cost-utility
analysis to see if the cost of the drug is affordable within the resources
allocated to it. Theme 4, ‘PHARMAC - No Stated Philosophy’ demonstrated
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