New Zealand's drug agency PHARMAC is moving to a more "permissive" system of assessing people seeking medicines that are not funded on the Pharmaceutical Schedule, in a move which is expected to double the scheme's spending in the first full year.
PHARMAC currently assesses over 2,000 applicants a year for the three Exceptional Circumstances schemes (community, cancer and hospital), but this process is being streamlined into a new Named Patient Pharmaceutical Assessment (NPPA) scheme, under which patients will no longer need to have rare conditions to be considered for funding.
PHARMAC is also creating a pathway to assess treatments more quickly for patients whose condition would significantly deteriorate or who would miss the opportunity for significant improvement during the usual time taken to assess a Pharmaceutical Schedule application.
The new arrangements - which are expected to increase the Exceptional Circumstances scheme spending from NZ$4 million now to around NZ$8 million in the first full year - have been introduced following criticism that the previous scheme was too restrictive, says the agency's chief executive, Matthew Brougham.
"We expect that one of the results of the change will be that more conditions experienced by small groups of patients will be considered for funding. Rarity is no longer the key consideration in examining funding applications - instead, we will focus on patients with unusual clinical circumstances, or those whose conditions are urgent and serious," he said.
Other features of the NPPA will include: - PHARMAC will, for the first time, be able to fund some medicines through the NPPA while they are under consideration for Schedule listing; - cancer and community treatments will be considered under the same scheme, which is likely to lead to more nationally-consistent decisions; - and greater clarity and enhanced transparency for clinicians of what might be funded, because PHARMAC will publish the outcomes of funding applications.
Mr Brougham also said that "the door remains open" to considering funding applications for chronic long-term conditions that are treated with very high-cost medicines.
"We will continue to treat these applications on a case-by-case basis and, as already occurs, where we consider the health gains from treatment justify the funding, and where funding is available, they will be approved,' he said.
The new NPPA scheme is set to take effect on March 1 2012.