New Zealand, which last week came bottom of a 14-nation table in terms of medicines uptake, has pledged to improve access to drugs which are not funded through the Pharmaceutical Schedule.

The three Exceptional Circumstances (EC) schemes run by the national pharmaceutical management agency Pharmac are to be reviewed, with the aim of providing better access to medicines not funded through the Schedule, Health Minister Tony Ryall said on Monday (August 2).

The three EC schemes – covering community (CEC), cancer (CaEC) and hospital (HEC) treatments – receive more than 3,000 applications each year, on behalf of patients who typically are suffering from rare conditions or whose clinical circumstances make standard treatment unsuitable, and the medicines can be expensive. Pharmac also considers requests for funding from individuals patients who cannot get their medicines through the Schedule and do not fit the requirements of the three EC schemes.

Announcing the review, Mr Ryall said the government is “determined to see New Zealanders get better access to medicines, and I will be interested to see the feedback from consumers, as well as the health and pharmaceutical sectors."__

Responders to the review will be able to comment on issues such as the current CEC requirement that a condition must have 10 or fewer people in New Zealand affected by the condition in order to be eligible for exceptional funding. “Whether arbitrary barriers such as this assist people in need is debatable – however, some type of access criteria will be required,” said associate health minister Peter Dunne.

The review has been welcomed by Denise Wood, chief executive of the Researched Medicines Industry Association (RMI) of New Zealand, who said it was “extremely positive news for those patients whose treatments are not provided for under the current system,” and “an important step towards improving access to medicines and enhancing health outcomes.”

The EC move was called for in the report of the High-Cost Highly-Specialised Medicines Review panel, which had been asked in May 2008 by the government to examine access to such medicines. The panel’s report concludes that “significant improvements are possible to how New Zealand’s medicines system operates” and that these will likely increase access to high-cost and/or highly-specialised medicines. However, it cautions that “there are no free-lunch ways" of increasing access to such treatments.

The panel emphasises that it is not calling for new prioritisation processes and pools of funding to be set up for high-cost, highly-specialised medicines per se, but says the current multiple pharmaceutical schedules and EC schemes should be replaced by a single New Zealand Pharmaceutical Schedule (covering community, cancer and hospital pharmaceuticals) and a single EC scheme.

The report’s 15 recommendations also call for: - the establishment of a New Zealand pharmaceutical formulary; - the national medicines regulator MedSafe and Pharmac to be directed to ensure that low-cost and highly-specialised medicines are more readily available than they are now; and - further attempts to encourage a “constructive national discussion about the ethical issues and funding dilemmas” related to high-cost, highly-specialised medicines.

- Meantime, Mr Ryall said yesterday that, as a result of the NZ$60 million drugs funding boost introduced by the government, 250,000 New Zealanders are now receiving government-subsidized medicines which were not available to them two years ago.

“The community pharmaceutical budget is NZ$710 million this year, and there’s another NZ$4 million for cancer treatments and other initiatives,” he said, adding: “when combined with Pharmac’s savings-related activity, the extra funding gives considerable scope for more New Zealanders to access new medicines, including new cancer treatments.”

In the past year, Pharmac has funded 13 new drugs and increased access to another 17, and already this year it has funded 11 new medicines and widened access to another seven, he said. New listings to take effect this year include the first Alzheimer’s disease drug, diabetes medicines and a new acne treatment.

The number of government-funded prescriptions has risen by 1.5 million since the 2009 budget, and the extra $60 million so far has increased per capita spending on pharmaceuticals from NZ$151 in 2008-09 to NZ$160 currently, the Minister added.