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Pharmaceutical Management Agency

information sheet

Getting clinical advice into our decision making

Medical Advice

Advice from doctors is an important part of PHARMAC’s decisions on medicines funding. This advice is received in a number of ways, including through expert committees. PHARMAC also keeps up-to-date with the latest clinical information, such as through ongoing professional development, monitoring of trial results and medical journal articles. How are PTAC members appointed?

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PTAC makes recommendations to PHARMAC, and these are one of the things we use to help us make decisions. PTAC operates under defined Terms of Reference which are available on our website. The Terms of Reference were reviewed in 2009, in line with a recommendation in Actioning Medicines New Zealand. Members are appointed by the Director-General of the Ministry of Health. Membership terms are usually three years and may be renewed. The process for appointing members is explained in an Appointment Protocol, also available on our website. What does PTAC take into account when providing advice? PTAC considers the same nine Decision Criteria as the PHARMAC Board when making recommendations. Some stakeholders have suggested that PTAC should focus exclusively on clinical effectiveness, since that is its major expertise. As clinicians, however, PTAC members are also concerned with, and can usefully comment on, the other Decision Criteria which include cost and opportunity cost, health inequalities and health need.

PTAC

Our main clinical advice comes from an expert committee of medical practitioners, the Pharmacology and Therapeutics Advisory Committee (PTAC). PTAC has been part of the health system since the 1930s and, in 1993, began providing advice to PHARMAC. PTAC’s role & relationship to PHARMAC PTAC provides objective advice to PHARMAC about changes to the Pharmaceutical Schedule, taking into account all nine Decision Criteria used by PHARMAC: • the health needs of all eligible people within New Zealand; • the particular health needs of Māori and Pacific peoples; • the availability and suitability of existing medicines, therapeutic medical devices and related products and related things; • the clinical benefits and risks of pharmaceuticals; • the cost-effectiveness of meeting health needs by funding pharmaceuticals rather than using other publicly funded health and disability support services; • the budgetary impact (in terms of the pharmaceutical budget and the Government’s overall health budget) of any changes to the Pharmaceutical Schedule; • the direct cost to health service users; • the Government’s priorities for health funding, as set out in any objectives notified by the Crown to PHARMAC, or in PHARMAC’s Funding Agreement, or elsewhere; and • such other criteria as PHARMAC thinks fit. PHARMAC will carry out appropriate consultation when it intends to take any such ‘other criteria’ into account. PTAC is an advisory committee to the PHARMAC Board and its members are not employed by PHARMAC (although they are reimbursed for the time they give to serving on the Committee). The Committee has 10 members who have expertise in examining clinical studies and broad experience and knowledge of medicines and the conditions they treat. PTAC meets four times a year and the Chair of PTAC attends the monthly PHARMAC Board meetings as an observer and to share PTAC’s views directly with the Board.

PTAC Subcommittees

Subcommittees provide more specialised advice to PTAC and PHARMAC on clinical areas such as cancer, diabetes, mental health, heart health (cardiovascular), and neurology. These subcommittees are a significant resource of over 50 health professionals providing expert clinical input into PHARMAC’s assessment of drug funding applications. They also help us to be aware of issues and concerns that doctors and health professionals are dealing with. Our current subcommittees are: PTAC Subcommittees • Analgesic • Cancer Treatments (CaTSoP) • Diabetes • Hormone & Contraceptive • Neurological • Osteoporosis • Respiratory • Tender Medical • Hospital pharmaceuticals • Anti-infective • Cardiovascular • Growth Hormone • Mental Health • Ophthalmology • Pulmonary Arterial Hypertension • Special Foods • Transplant Immunosuppressant

PHARMAC Information sheet

Special access panels

PHARMAC contracts with health professionals to apply criteria to patients seeking access to some high cost medicines. We currently have six panels for: • Cystic Fibrosis • Gaucher Treatment • Growth Hormones • Pulmonary Arterial Hypertension • Multiple Sclerosis • Treatments for chronic myeloid leukaemia The panels assess the clinical situations of patients seeking funded access to treatments. The treatments require patients to meet defined access criteria, and the health professionals on each panel use their expertise to assess individual applications. The Panels can also provide advice to PHARMAC and review any changes suggested to the access criteria.

Other clinical input

PHARMAC staff PHARMAC employs a number of people with clinical expertise – in medical practice, pharmacy or the science of pharmacology. A large number of PHARMAC’s staff have experience in medical or scientific fields. Consultation The views of health professionals are an important part of our decisions on pharmaceutical funding proposals. Often clinicians can identify important clinical terms and technical adjustments that help us make better decisions. We aim to include clinicians in our consultations – in many cases meeting with them face to face – as much as possible. Applications from Health Professionals As well as providing views through formal consultation, clinicians can also bring submissions to us to have medicines funded, either through applications for named patients or Pharmaceutical Schedule listings. When we receive applications from clinicians seeking funding for medicines, these are treated in the same way as applications from pharmaceutical companies, with PTAC’s advice being sought and economic analysis being undertaken for Schedule listing applications. Exceptional Circumstances PHARMAC contracts with health professionals to apply criteria on applications for named patients in exceptional circumstances. See the Targeting Medicines Information Sheet for more details.

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