This is the text extract for 2011-09 Clinicians Newsletter, browse documents here.

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Pharmaceutical Management Agency

Clinicians’

“Make life easier, always think generically”

Newsletter

September 2011

Legislation changes impact on the Pharmaceutical Schedule

The Medicines Amendment Regulations 2011 and the Misuse of Drugs Amendment Act 2011 were gazetted recently which resulted in the following two changes to the Pharmaceutical Schedule.

Widening of Access

Generic brands of olanzapine listed and removal of Special Authorities There are now three brands of olanzapine (Dr Reddy’s Olanzapine, Olanzine, and Zyprexa), therefore if these drugs are prescribed generically the fully funded option will always be dispensed.

All brands of olanzapine listed in the Pharmaceutical Schedule will be accessible without a Special Authority for subsidy as the Special Authority for Subsidy for the Zyprexa brand of olanzapine tablets and the Zyprexa Zydis brand of olanzapine wafers is to be removed from 1 September 2011. Note that the subsidy for all strengths of Zyprexa tablets and Zyprexa Zydis will be reduced from 1 September 2011 to the same level as the other funded brands of olanzapine and will therefore incur a manufacturer’s part charge from 1 September 2011. This is because Eli Lilly has advised that it will not be decreasing the price of Zyprexa and Zyprexa Zydis.

1. Brand substitution Pharmacists may now substitute an alternative brand of a prescribed medicine provided:

• There are no clinical reasons why substitution should not occur • The prescriber has not marked the prescription with a statement such as “no brand substitution permitted”, and • The pharmacist records details of the brand substitution on the prescription and informs the patient of the change of brand. This means that if a clinician writes a prescription using a brand name, the pharmacist may substitute an alternative brand at their discretion. This will particularly apply where a script item is for an unsubsidised brand but an alternative fully subsidised brand is available. It is still preferable to write scripts using generic names wherever possible.

2. Thalidomide reclassification Thalidomide has been reclassified as a prescription medicine. Prescriptions for thalidomide should now be on a standard prescription form and no longer needs to be prescribed on the triplicate controlled drug prescription form. This change makes no difference to access to the medication which will still have to be written by the appropriate specialist and dispensed through a DHB hospital pharmacy.

Budesonide 3 mg capsules – wider access Budesonide access will be widened to include patients with microscopic colitis, patients with Crohn’s disease who have psychiatric problems or with relapse during pregnancy, and patients with Gut Graft vs Host disease (GVHD). The Special Authority approval period has also been lengthened from 3 to 6 months. The Special Authority that applies to budesonide 3 mg capsules (Entocort CIR) will be amended from 1 September 2011.

The restriction that permitted patients to have only 1 prior approval in the last year will be removed from 1 September 2011.

Brand Changes

Candesartan – Candestar brand now listed A new brand of candesartan will be subsidised from 1 September 2011. Candestar 4 mg, 8 mg, 16 mg and 32 mg tablets will be subsidised subject to the same Special Authority and maximum daily dose restrictions as the Atacand brand of candesartan.

The Atacand brand will continue to be listed in Section B of the Pharmaceutical Schedule subject to its current subsidy restrictions.

Restriction of access

Discontinuation of Ensure powder 400 g pack and Ensure Plus 237 ml can coffee latte flavour There will be discontinuation of all flavours of the 400 g pack size of Ensure powder from 1 March 2012; however, Ensure powder 900 g pack size in chocolate and vanilla will remain available and fully subsidised via Special Authority. The 400 g pack size will be delisted from the Pharmaceutical Schedule as Abbott Nutrition is discontinuing this line.

Ensure Plus 237 ml can, coffee latte flavour, has also been discontinued by Abbott Nutrition and will be delisted from the Pharmaceutical Schedule from 1 March 2012.

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Pharmaceutical Management Agency - Clinicians’ Newsletter - September 2011

Other Changes

Litak injection delist is now revoked Litak (cladribine) 2 mg per ml, 5 ml injection was to be delisted from the Pharmaceutical Schedule from 1 September 2011. This decision has now been revoked to cover an out-of-stock on Leustatin injection 1 mg per ml, 10 ml. Litak will continue to be subsidised under its current subsidy restrictions of PCT only – Specialist. Litak is an unapproved medicine in New Zealand and is supplied under Section 29 of the Medicines Act 1981.

Named Specialist for antiretrovirals

Below is a list of currently approved named Specialists that the Ministry of Health has approved to prescribe HIV antiretroviral agents in New Zealand

Auckland

Dr Sunita Azariah Dr Emma Best Dr Simon Briggs Dr Rod Ellis-Pegler Dr Rick Franklin Dr Rupert Handy Dr Jacqueline Hilton Dr David Holland Dr Joan Ingram Prof. Diana Lennon Dr Mitzi Nisbet Dr Nicky Perkins Dr Murray Reid Dr Stephen Ritchie Dr Sally Roberts Dr Simon Rowley Dr Mark Thomas Dr Leslie Voss Dr Liz Wilson

Napier

Dr Andrew Burns Dr Richard Meech

Items of Interest

Dantrolene sodium (Dantrium) funding for certain groups of patients Dantrolene sodium 25mg and 50mg capsules are registered for use in controlling the manifestations of clinical spasticity. Dantrolene sodium has a patient part charge as a result of a supplier price increase, and subsequent clinical advice that most patients would be able to be switched to an alternative, fully funded muscle relaxant, baclofen.

However, we have become aware of a few patients with severe spasticity and were previously well-controlled on dantrolene sodium, who are not able to be controlled on maximal tolerated doses of baclofen alone. In these specific circumstances, we will consider continuing the full subsidisation of dantrolene for these patients. To request consideration of full subsidy for a patient, you should write to the Medical Director, PHARMAC. In your letter, please provide a brief review of clinical situation as described above as well as the following information: • patient details • the maximum dosage of dantrolene that your patient has been on and now requires • the dosage of baclofen that has been trialled by your patient and outcome of this trial • a pharmacy selected by your patient to provide supplies of dantrolene

Palmerston North

Dr Anne Robertson

Wellington

Dr Tim Blackmore Dr Nigel Raymond Dr Richard Steele

Nelson

Dr Richard Everts

Christchurch

Dr Stephen Chambers Dr Sarah Metcalf Dr Alan Pithie Dr Tony Walls

Dunedin

Dr Geoffery Clover Dr Igor Melnychuk

Hamilton

Dr Graeme Mills Dr Jane Morgan

Diabetes Nurse Prescribers’ prescriptions The demonstration site project for diabetes nurse prescribing moves into its evaluation phase after September 2011. However, the twelve named Diabetes Nurse Prescribers will continue to be able to write subsidised prescriptions after September. They will continue to prescribe under the collaborative framework with Diabetes Specialists. The current list of medicines they are able to prescribe will not change. We will publish further information on the result of the evaluation as it comes to hand.

Tauranga

Dr Massimo Giola Dr Katherine Grimwade

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Pharmaceutical Management Agency - Clinicians’ Newsletter - September 2011

Pharmaceutical Management Agency

What’s cooking in Prescription Kitchen?

PHARMAC has been involved in a new and innovative way to deliver medical education to clinicians. Prescription Kitchen, the first in a series called HealthQ, was a collaboration between PHARMAC, BPACnz and Mobile Surgical Services that provided an innovative way to deliver continuing medical education (CME) to health professionals. As part of this, a live and interactive CME session was held on Thursday 5 May and screened on Sky TV.

Special Authority vigilance

Special Authority is the mechanism PHARMAC uses to target medicines to people who need them most. The system is only as good as our ability to ensure it is used properly, so we routinely commission audits to check the system is being used as intended. During the course of an audit into the Special Access process (which is similar to the Special Authority process) for the ADHD drug Ritalin SR, we became aware of some irregularities around some doctors’ use of the forms. Having identified particular concerns in relation to two doctors, we made a complaint to the Medical Council, whose Professional Conduct Committee decided to lay charges against the doctors before the Health Practitioners’ Disciplinary Tribunal. The charge against one of the doctors was withdrawn after he acknowledged that he had completed some of the criteria in the special access forms in error in the context of a busy practice. The charges against another doctor, Dr John Anthony Hanne of Auckland, proceeded to a tribunal hearing. During the course of the hearing the tribunal agreed to the withdrawal of the charges after Dr Hanne agreed to make a statement accepting that his actions fell below the standards of optimal practice, that he regretted the errors, and that he will take more care with completing forms in future. The full decision can be found at http://www.hpdt.org.nz/Default. aspx?tabid=293. PHARMAC will continue to commission regular audits of Special Authority Processes.

MAY 2011

Let the facts speak for themselves?

Pharmaceutical Management Agency

When we live in a world where evidence is meant to trump opinion, you’d think facts were all that’s needed to convince others of the strength of an argument. But facts can be mistakenly connected to other facts, leading to incorrect interpretations. We’ve seen a bit of this around the topic of PHARMAC lately. Take this statement for example: “New Zealand’s per capita spending on pharmaceuticals is below the OECD average.” The statement is undeniably true. But what does it mean, and is it good or bad? If you are a pharmaceutical lobby group calling for more funding for medicines, the meaning put around this fact is a claim that spending more on medicines leads to better health outcomes (despite the report citied1 showing the United States, which has the highest prices and highest per capita spend on pharmaceuticals, also has the highest mortality from preventable diseases). From PHARMAC’s point of view, the fact that we spend less per capita on pharmaceuticals is pretty good. Because New Zealand’s population health outcomes are broadly in line with OECD averages, the fact illustrates the value for money PHARMAC achieves for our medicine funding system. Here’s another fact: “New Zealand’s mortality from preventable diseases has been improving faster than the OECD average.” We think this fact is a good thing. It also comes from the same report the industry

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>> • Patients with severe genetic diseases (inborn errors of metabolism) will have easier access than before. • Children who need specialised infant formulae will need to follow international guidelines – these require people to try simpler and cheaper formulae before more complex and expensive formulae. We have received the most feedback from people about changes to adult sip feeds. They come in two types – ready-made liquid preparations and powdered versions that need to be mixed with water. The ready-made versions have been more expensive for PHARMAC to fund. We’ve had advice that the powdered and ready-mixed versions of these products are pretty much the same, so we think it’s reasonable to pay the same subsidy for both. Powdered drinks will be fully subsidised, and people can choose to pay the difference if they opt for the ready-made liquid products. In making the funding changes, we’ve thought about people with particular needs like those who are tube fed and rely on liquid feeds for their full nutrition (known as enteral feeds). We’ve created rules so that tube-fed patients can have ready-mixed enteral feed preparations fully funded and not have to pay a part-charge. We’ve also worked to ensure that access to funded Special Foods is appropriately targeted so that the people who are in genuine clinical need receive funded products. Full details and patient information about the changes are available at http://www.pharmac.govt.nz/patients/SpecialFoodsChanges

Te Matatini and Whˉ nau Hauora Village a

This first session focused on the current Pharmaceutical Schedule changes to Special Foods, and supplemented the other medical education that is occurring. The Sky TV session, compered by veteran A PHARMAC-led initiative was a major drawcard broadcaster Ian Fraser, involved live panel discussion with expert at the Te Matatini o te clinicians as Rā national kapa haka festival in Gisborne on 16-20 February.well as pre-recorded video clips and opinion pieces in order to provide as dynamic an approach to CME as possible. PHARMAC worked with a range of groups including Tairawhiti District There was also the Health Board, Plunket, National Heart Foundation, Te Hotu Manawa opportunity for health professionals to text or email questions they Māori, Quit Group, Māori Pharmacists Association, Turanganui a Kiwa had for the panel both in advance of the show, health and Midlands Health Network to create a as well asHauora its screening. Health professionals, including GPs, Whānau during paediatricians, geriatricians and dietitians were sent an ‘invite’ to tune Village for the duration of the festival. in to the screening. Services offered included men’s heart health checks, diabetes We will be monitoring the response to Prescription Kitchen. Should screening, well child checks, cancer services including cervical this first session screening, nutrition and physical activity guidance and smoking be successful, a further two Sky TV based sessions may cessation advice and support. Specialist services be developed for other medical subject matter during 2011. included sexual health and oncology (cancer) expertise, medications advice and counselling, all provided by senior Māori clinicians. The village concept was extremely popular, with 2,500 people visiting the Village (out of approximately 50,000 people attending the festival). PHARMAC and the festival organisers put a lot of effort into creating an environment where people felt safe and welcomed and were willing to take part in the various services on offer. This meant that, despite being set up in little more than a tent in a field, highly professional services were offered in a setting that made people feel at ease and well cared for. Services provided during the festival included: • 303 men had their heart and diabetes status checked (of these, 145 were considered high risk – greater than 15% chance of a heart event)

FORUM

– save this date

The PHARMAC Forum is coming – make a note of this date: 17 February 2012. The Forum has become an important part of PHARMAC’s business and getting stakeholder input to our work. For the next Forum, we’re looking at additional opportunities for getting input from consumers and front line health professionals, in particular pharmacists and General Practitioners. We plan on holding regional ‘mini-Forums’ later in 2011, which will give people a further opportunity to contribute to the discussion around Forum topics. We’ll provide more information, including dates, about these mini-Forums in the near future.

has been using to promote its case that it is a bad thing that New Zealand spends less on pharmaceuticals. Unfortunately such recent comments haven’t had a lot of factual backing. Rather, these arguments need to be unpicked and corrected, something that is readily done using documents easily obtained through our website or from other sources. And that’s a fact.

• 200 women had diabetes checks • 20 women had cervical smears

PHARMAC Seminar Series – Upcoming Seminars

The PHARMAC Seminar Series provides high quality educational seminars for a range of health professionals. The seminars are held in Wellington and the cost to attend is $100 + GST. PHARMAC covers the cost of travel, including flights, to and from the seminar and provides catering on the day. For further information on the seminars below, and to register for a place, head to our website: www.seminarseries.pharmac.govt.nz Dates (2011) Topic

Diabetes, Pre-Eclampsia and Pregnancy Complications

“A MAN WITH A CONVICTION is a hard man to change. Tell him you disagree and he turns away. Show him facts or figures and he questions your sources. Appeal to logic and he fails to see your point.” -Leon Festinger

• 200 contacts were made with families with young children The Village concept emphasised the idea that healthcare is a concern for families as a whole, not just for individuals. Many of the people seen at the Village did not have regular contact with health professionals. Two of the women who had cervical smear tests had never had one before. ISSN 1179-7401

Measuring The Health Of Nations: Updating An Earlier Analysis Ellen Nolte and C. Martin McKee Health Affairs, 27, no. 1 (2008): 58-71 doi: 10.1377/hlthaff.27.1.58

PHARMAC and its partners in the Whānau Hauora Village feltthe Government agency responsible for deciding which medicines are subsidised for New Zealanders. PHARMAC is the It manages spending concept, bringing together a range of services working together on pharmaceuticals for the District Health Boards, and ensures that a comprehensive list of medicines (the Pharmaceutical Schedule) is subsidised for New under one roof, worked extremely well. The concept of a health Zealanders. village is an exercise they are keen to repeat at future festivals and Level 9, 40 Mercer Street, PO Box 10-254, Wellington 6143, New Zealand Contact: PHARMAC, the Whānau Hauora Village has been invited back to be part of the Te Phone: +64 (0)4 460 4990 - Fax: +64 (0)4 460 4995 - www.pharmac.govt.nz Matatini festival in 2013.

inPharmation

PHARMAC publishes a quarterly email newsletter, inPharmation, that includes news and updates on developments around PHARMAC and pharmaceutical issues. If you would like to receive inPharmation, contact simon.england@pharmac.govt.nz.

Description

2 December

This seminar is a repeat and is aimed towards LMC practitioners or practitioners providing care to women during pregnancy.

5 December

Adolescent Health

All health workers involved in caring for young people, but especially relevant for GPs, practice nurses and counsellors working in the community. (This is a repeat seminar).

Rheumatic Fever 7 December (Part II – Invitation only) Please note we will be identifying and inviting registrants for these seminars from the relevant high risk areas.

ISSN 2230-4703 (Print) ISSN 2230-4711 (Online) Special Authority Queries: 0800 243 666 General Questions: 0800 66 00 50 (9am – 5pm Monday to Friday) Online version of Prescriber newsletter: http://www.pharmac.govt.nz/healthpros/CliniciansNews Inpharmation newsletter: http://www.pharmac.govt.nz/patients/ourviews/inpharmation. Newsletter feedback: email susan.haniel@pharmac.govt.nz Please note this is not a complete reference to all changes occurring from 1 September 2011, for the full reference; please consult your Update to the Pharmaceutical Schedule.