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Pharmaceutical Management Agency

information sheet

Targeting medicines

Why target medicines?

Some medicines treat many illnesses and how they are used is the decision of the health professional writing the prescription. When it comes to funding medicines, we want effective treatment to be available to the people who need it most. In some cases, targeting can help us to identify the people who will benefit the most from a medicine. In the same way we assess each medicine to decide if it is suitable for funding, we must also assess which patients might best benefit from that medicine. If people who won’t benefit from the medicine have it provided, then money is wasted and that means there is less funding available for other medicines or health services.

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Exceptional Circumstances Funding for named patients in exceptional circumstances (EC) is a way of funding medicines that are not otherwise funded in the community or in hospitals. Decisions on EC are based on a clinical assessment of an individual patient’s needs. Typically, we receive about 2,000 applications for funding each year across three schemes that will operate until 29 February 2012:

• Community EC - for patients with rare or unusual clinical situations. PHARMAC manages panels of clinicians who make recommendations or decisions on EC funding. The funding is drawn from the Combined Pharmaceutical Budget. • Hospital EC - enables DHB hospitals to dispense medicines for people being discharged from hospital. PHARMAC assesses applications on a case-by-case basis with the sole criterion being cost-effectiveness to that hospital. • Cancer EC - allows DHBs to fund, on application to PHARMAC and where certain criteria are met, cancer medicines that are not otherwise funded. During 2010, PHARMAC began a review of the EC schemes, in line with a recommendation in Actioning Medicines New Zealand and the Review of High-Cost, Highly-Specialised Medicines. From 1 March 2012 the Named Patient Pharmaceutical Assessment scheme commences. It has three pathways to assess applications for named patients in exceptional circumstances: - Unusual Clinical Circumstances - Urgent Assessment - Hospital Pharmaceuticals in the Community. Details can be found on PHARMAC’s website

How do we target medicines?

Here are some of the ways we may target medicines.

Published Guidelines The New Zealand Guidelines Group (www.nzgg.org.nz) develops best-practice guidelines, including guidance on pharmaceutical prescribing, for a number of conditions. In some cases these guidelines, or summary statements based on the guidelines, are included in the Pharmaceutical Schedule. Endorsement This requires a prescriber to write on the prescription that their patient meets the criteria for full subsidy. This can be used where a treatment (such as antibiotics) is required urgently and there isn’t time to apply for a Special Authority approval. Special Authority This is our most frequently used targeting tool. Usually, the published Special Authority criteria define the clinical circumstances of patients who can receive funding for the medicine. People may first be required to try a less expensive medicine or the medicine may need to be prescribed by a particular type of health practitioner.

Special Authority applications are processed by Ministry of Health Sector Services. We’ve worked with them to improve the Special Authority process, and now the majority of Special Authority applications are processed electronically, usually while the patient is still with the prescriber.

Special Access Panels Some medicines are very expensive, and to help ensure these are appropriately targeted we manage panels of expert doctors to apply the criteria on which patients can access treatment. Approximatly 4,000 panel applications are recieved each year.

Contacting Us

Call us on 0800 66 00 50 (between 9am and 5pm, Monday to Friday), Write to us at: PHARMAC, PO Box 10 254, Wellington – we respond to all letters Email us at enquiry@pharmac.govt.nz – we respond to all emails Information Sheets on various PHARMAC topics are available from our website: www.pharmac.govt.nz/patients/infosheets If you have specific areas of interest (such as consultations, committees or vacancies), visit our website and subscribe to news feeds in the area(s) of interest to you: http://pharmac.govt.nz/feeds