This is the text extract for Pharmaceutical Funding Application, browse documents here.

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How can the medicines funding process be improved?

Jackie Evans PhD Therapeutic Group Manager

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Health care wants will always exceed resources available …

Demand

Ability to pay

… so choices need to be made

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PHARMAC’s role

“To secure for eligible people in need of pharmaceuticals the best health outcomes that are reasonably achievable from pharmaceutical treatment and from within the amount of funding provided”

NZ Public Health & Disability Act 2000

Maximise what we get (health outcomes) § Limit what we miss out on

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Working on behalf of DHBs (the funders)

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Managing the medicines budget

Budget set annually (Minister) Forecasting

How much is committed (past decisions)? How much is available?

Free up Funds

to invest in new treatments

Invest Funds

for additional health gain

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Freeing up funds (fluoxetine cap 20mg)

1993: $1.92 per cap

2004: 5 cents per cap

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PHARMAC uses 9 Decision Criteria

1. 2. 3. 4. 5. 6. 7. 8. 9.

Health needs of eligible people Health needs of Maori and Pacific peoples Availability and suitability of existing treatment Clinical benefits and risks Cost-effectiveness Overall budgetary impact Direct cost to health service users Government priorities for health funding/Government objectives Other criteria (with appropriate consultation)

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The funding process

Step 1: Receipt of Proposals Step 2: Medical Advice – PTAC Step 3: Economic Assessment Step 4: Prioritisation for funding Step 5: Negotiation Step 6: Consultation Step 7: Decision Step 8: Implementation

Consider evidence

Assess relative value

Outcome

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Consider the evidence

Step 1: Receipt of Proposals

Funding proposals initiated by anyone

Step 2: Medical Advice – PTAC

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Pharmacology and Therapeutics Advisory Committee (PTAC) Experts in critical appraisal, appointed by the Ministry of Health May seek advice from its specialist sub-committees Independent and objective advice Evidence based assessment

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Is it safer/more effective/more cost-effective than other funded medicines?

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All 9 decision criteria considered Makes recommendations to PHARMAC

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Assess relative value

Step 3: Economic Assessment

Budget Analysis

medicine cost + other costs/savings to sector (eg DHB resources)

Cost Utility Analysis •

Provides information on relative value cost per ‘QALY’ (Quality-Adjusted Life Year)

Treatment A

Costs Health Outcomes Costs

Treatment B

Health Outcomes

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Assess relative value

Step 4: Prioritisation

Takes into account all Decision Criteria Identifies lead candidates for funding

Step 5: Negotiation

Sometimes difficult to talk about $ and health together paying more than necessary = less $ available for other medicines Aims to achieve best value per $ spent May lead to re-evaluation of Steps 3 and 4

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Outcome

Step 6: Consultation

Proposal published Wide consultation lists used (easy to join) Want to ensure all relevant information considered

Step 7: Decision

Made by the PHARMAC Board (or CE within set limits)

Members appointed by the Minister of Health Range of backgrounds and skills

Decision informed by

9 Decision criteria Consultation responses (all considered) PTAC recommendations Views of PHARMAC staff

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Outcome

Step 8: Implementation

Decisions announced Media releases Notification letters Schedule updates

Resources as useful Patient focussed Prescribers/dispensers

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Keeping informed

Meet and greet www.pharmac.govt.nz

Funding Applications Report PTAC minutes Consultation letters Notification letters Pharmaceutical Schedule and Updates Media releases

Automatic mailing lists (easy web-based joining) 0800 66 00 50 firstname.lastname@pharmac.govt.nz

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can we improve the funding process?

•How