PHARMAC is considering declining 97 inactive medicine funding applications. Previously inactive applications have remained on PHARMAC’s books, despite being unlikely to be approved for funding. This has caused confusion as to if they will be funded and frustration at the lack of clarity.
“We have heard from New Zealanders that PHARMAC needs to make final decisions on funding applications. We have heard that people want more certainty, even if this is a decision to decline funding,” says PHARMAC’s director of operations Lisa Williams.
PHARMAC has several “ranking lists”, which support funding decision-making. These include:
- Options for investment – medicines that we want to fund. Medicines on this list are ranked in order of priority for funding. Some are new medicines, and some are medicines we already fund that we would like to fund for wider use.
- Only if cost neutral or cost saving – medicines that we would fund if they cost the same as, or less than, a different medicine we already fund. Generally, these are medicines that our clinical advisors consider would not deliver better health outcomes than those already available.
- Recommended for decline – medicines that our expert clinical advisors have recommended to decline so we are not actively working on them. Broadly these are medicines that our clinical advisors consider add no value or are harmful. A recommendation from our advisors is not a decision by PHARMAC.
- Under assessment – proposals where clinical advice is being sought or that are awaiting health economic evaluation, prior to being placed on one of the above three lists.
“When you manage a fixed budget, there will always be more medicines than we can afford to fund. This means we need to make some difficult choices. Often, when talking about an unfunded medicine, people say that PHARMAC has decided not to fund it.
“Most of the time an application is still open, but PHARMAC is focusing its attention, and available funding, on other new medicines. We’ll always have medicines that we’d want to fund when there is budget available.”
There are, however, also applications that are not likely to ever be taken forward for funding, which are sitting on our recommended for decline list.
“Of the 97 applications that we’re proposing to decline, most have been recommended for decline by our clinical experts. This might be because there are other funded medicines for the same condition, the medicine would provide no additional benefits over other treatments we already fund, and/or the medicine may be harmful.
“Before we move ahead with declining any of the applications we consult widely with health professionals, patient groups and suppliers, to make sure we hear their views; including whether there is any new information about the medicines that we are currently unaware of.”
Since 2019 PHARMAC has formally declined 77 inactive medicine funding applications. The 97 medicine funding applications currently being considered for decline involve 85 different medicines.
“We are committed to being more open and transparent. Removing applications that won’t be progressed helps to provide certainty and a clearer picture of what medicines are waiting to be funded,” concludes Ms Williams.