Latest developments

December 2009 – check our newsletter (pdf) for commentary about progress with the medicine strategy implementation

May 2009 – ATM welcomes government boost to medicine funding. Read our press release (pdf) about the extra money allocated in the may 2009 budget.

September 2008 – The Access to Medicines Coalition has expressed alarm at the actions of District Health Boards and Pharmac in failing to comply with the government’s medicine strategy. We believe our commitment to this strategy has been betrayed. Read our press release for details.

2 May 2008, ATM request for information from Pharmac – available in Word and pdf formats. A similar letter was also sent to the Ministry of Health on the same date to seek information about the timetable for various reviews indicated in the medicines strategy. Replies (in pdf format) from Pharmac and the Ministry are available.

Medicine Strategy launched December 2007

The government’s December 2007 strategy announcement Medicines New Zealand and the accompanying plan for Actioning Medicines New Zealand were greeted with disappointment by most stakeholders at the lack of immediate action to fix the most pressing issue – a serious underfunding of medicines for New Zealand patients. But time to reflect on the details of the strategy and action plan gives a far more satisfying read and cause for optimism about the future. This initial assessment of the strategy has been endorsed by the ATM Coalition’s working group in February 2008.

In the strategy government has delivered a mix of major and subtle changes to the system, all adding up to a significant change of direction:

• Pharmac’s wings have been significantly clipped.
• Patient access to affordable medicines is now a strategic outcome.
• Equity and affordability for patients are elevated to major principles that will guide decisions, and given equal standing to cost effectiveness considerations.
• Protection from substantial financial costs due to ill health is noted as an overarching health system outcome.
• Steps will be taken to protect patients from negative consequences of changes to subsidised brands.
• Detailed reviews will examine exceptional circumstances provisions and specialist-only prescribing rules.
• Greater consultation and feedback processes are mandated.
• There will be more transparency in budget setting and District Health Boards will be more accountable for their roles in this.
• Reviews will ensure the independence of PTAC’s technical advice to Pharmac, and examine the role of the Consumer Advisory Committee.

ATM expects there will be much improved outcomes in the medium term as this strategy beds down, provided there is commitment to its implementation. District Health Boards and Pharmac will work to a principles-based approach to setting the overall budget. If properly applied, this should see improvements in total funding available, though we are sure that a government intervention is still needed to correct the chronic underspend on medicines.

Of particular interest is the rejection of Pharmac’s proposed approach to decisions about high cost therapies. Pharmac submitted a detailed paper on this topic to the Ministry consultation, essentially arguing no special consideration for high cost medicines, and a wish to rely on basic cost-utility criteria, but there is no support for their proposals at all in the strategy or action plan. In fact the Pharmac approach to high cost therapies is contradicted, by implication, by the specific inclusion of references to equity, access, affordability, and protection against substantial financial costs. Commentary in the accompanying papers to such things as “ensuring that New Zealanders can get access to the medicines they need” and “taking account of and reflecting community values”, further rejects Pharmac’s crude utilitarian approach and incorporates the themes we proposed. This seems to be a significant victory for the submissions we made specifically challenging Pharmac’s papers on high cost medicines.

Those of us involved in many months and years of detailed work to achieve this strategy, should feel very pleased with the strategy produced by government. It must have been very tempting for government to let their direct financial interest in containing costs, prevail as the guiding themes in their strategy. That, after all, is what we have had for the last decade and a half - a narrow cost containment approach by all the governments throughout that time. Instead the government has risen to the challenge we put to them in our submissions, and set a visionary medicines strategy that strongly incorporates patient interests and community values, at last. The government’s response is most welcome, though there is still a lot of work to do to achieve our overall objectives.

Significant work will be required of support groups and other stakeholders to participate in the reviews and consultation processes, perhaps as much work over the next few years as was put into achieving this strategy. Changes occurring with new faces on the board of Pharmac and changes pending in Pharmac management also signal work required to develop the relationships and communications needed to ensure things go as planned.

Support group involvement will need to change too as we adapt to a more open and transparent model for decision-making about medicines. We have more recognition as stakeholders in the strategy and we have roles to fill. We will need to be less reactive and more engaged in the whole process and seek out opportunities for us to take initiatives in a more accountable and more patient friendly system. The strategy and action plan can be found on the Ministry of Health website.

Background to the medicine strategy

The ATM Coalition was formed prior to the 2005 general election and officially launched in November 2005. Our mission has been the improvement in access to medicines for New Zealanders, and the prime objective has been the development of a National Medicines Strategy as the most likely means to achieve our mission. In response to our calls and the concerns expressed by many patients and health professionals, the government announced in April 2006 that it would proceed with the establishment of a medicines strategy. The text of the announcement from the office of the Minister is available here.

In December 2006, the government announced the release of a public consultation document Towards a New Zealand Medicines Strategy. A copy of the government announcement is available here. The consulation document is available from the Ministry of Health website, at this page. The ATM Coalition welcomes the draft medicines strategy but is concerned by inadequate direction given to key decision makers. A copy of ATM's respose to the government's announcement is available here.

Following the Ministry’s release of its consultation document, Pharmac followed on 18 December 2006 with a consultation on high cost therapies. A copy of the covering letter from Pharmac, the two major reports they commissioned, and several associated reports from other reviewers, can be found at this link on the Pharmac website. Both reports will receive close scrutiny by the ATM Coalition and detailed submissions will be made in the New Year. Initial assessment confirms that we had well-founded fears about the narrow focus of the Pharmac report, when we responded to the Ministry’s consultation release.

The Ministry’s document had some reason for optimism in its reference to access as an objective, a principles-based approach, and adding in equity as the first time that any ethical considerations get specific mention in any part of medicine policy in New Zealand. Pharmac’s document is very disappointing. They have maintained their narrow focus on cost utility and have blatantly overlooked the important social and ethical issues suggested by some of their commissioned reports, even after they had artificially narrowed the terms of reference for those reports and so avoided the questions that needed to be addressed and publicly debated. The ATM response to the release of Pharmac’s papers can be found here.

In March 2007 the Access to Medicines coalition presented Pharmac with a response to their discussion papers on high cost pharmaceuticals. We expressed our frustration at a very poor analysis by Pharmac of the issues under consideration and pointed out to them a number of ways in which their current policies and practices fail to comply with the purposes of the NZ Health and Disability Act, and with Pharmac’s own statutory functions. Click here to read our submission. ATM will express these concerns to the Ministry of Health and to government as part of the wider consultation on the development of a medicines strategy.

In April 2007 ATM presented the Ministry of Health with a substantial submission in response to their consultation on a Medicines Strategy for New Zealand. Many months of work by the ATM working group, backed up by research by expert advisors, identified a range of problems with current processes for accessing medicines in New Zealand. We have proposed a number of principles that should be incorporated into the strategy and suggested important changes that need to be made to the structures and governance of medicines decision-making. Read our submission in Word format or in pdf format.

In early July 2007 ATM wrote to the Associate Minister of Health, Peter Dunne, seeking clarification of aspects of Pharmac's roles, responsibilities and performance criteria. We wish to identify how their own approach might skew the performance of objectives they should be pursuing under the Act. We also sought information about resources they have invested in the medicine strategy process. You can read this letter from ATM at these links in Word or pdf format. Unfortunately the response from the Minister did not give clear answers to the questions posed, but instead referred us to Pharmac for any information we wanted about their internal operations, and also declined our request for funding support. The issues were not further pursed as by the time of the reply the issues were overtaken by the pending release of the medicine strategy, and our point had been made.