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

decisions on such claims, as far as is practicable, comply with the requirements
of distributive justice and these could be based on the following principles:
1. Decisions are informed by an analysis of the likely clinical effectiveness of
the proposed medicine;
2. Decisions are informed by a costs and benefits analysis of substantive
opportunities for spending the PHARMAC budget and
3. Decisions are informed on the basis of fairness to the applicants.
One suggested system for PHARMAC could be to ensure that panels of decision
makers are constituted to draw on the models of New Zealand ethics committees
and the NICE’s Citizen Council in the United Kingdom. The panels might be
advisory to the PHARMAC Board who will make final decisions on such claims.
The panel could examine either Hope, Reynolds and Griffith’s four step process
where conflicting values are used in explicit cases (Hope, Reynolds, & Griffiths,
2002) and Daniels and Sabin’s ‘Accountability for Reasonableness’ framework.
Such a capability would assist the panels to locate their thinking and decision
making in an ethical framework.
Under this suggested system, the first criterion for payment by PHARMAC in
deciding on provision of medicines under such conditions might be that
PHARMAC can demonstrate that the medicines are affordable on an ongoing
basis. This system should not undermine the provision of an adequate range,
quality and quantity of medicines for the general New Zealand population. The
material received under the Official Information Act requests (outlined in
Appendix 9) indicated that PHARMAC has both the capability and processes for
making such determinations. Where medicines cannot be afforded on an ongoing
basis, given the government’s health priorities and funding allocations,
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