Many New Zealanders are not getting free prescription medicines when they should, new research has found.

Most people pay NZ$3 per medicine when they pick up a prescription from a pharmacy, but after paying for 20 prescription items in a year, individuals or families should then become exempt from the charge. However, ongoing research being conducted by the University of Otago and Victoria University shows that 40% of people were still paying the prescription fee for 90% of the medicines they received after they should have been entitled to the exemption.

"In fact, the average amount people paid for medicines hardly dropped at all after they reached 20 items," commented associate professor Jackie Cumming, from Victoria University.

The majority of the individuals identified as having more than 20 items dispensed in one year were from the most socio-economically deprived areas, the researchers also note.

Data from the New Zealand government's drug-buying agency, PHARMAC, shows that 180,000 people pay for prescriptions after they should be exempt, costing them around NZ$2.5 million a year in total.

These data are likely to underestimate the extent of the problem because the exemption should apply after a family has had 20 prescription items, said Dr Simon Horsbrugh of the University of Otago.

"Neither our study or PHARMAC can identify families from the data, so these estimates are based on individuals. Because many of these people will have family members who also get prescriptions, they should be receiving free prescriptions after fewer than 20 items," he said.

Standard charges for prescription medicines in New Zealand will go up from NZ$3 to NZ$5 in January 2013. This should mean that the maximum that families will be required to pay will be NZ$100 a year. However, Professor Pauline Norris points out that, given the exemption after 20 items does not seem to work in practice, people with multiple health problems, who use a lot of prescription medicines, will potentially have to pay much more than that.

Meantime, PHARMAC's latest annual report, covering the year ended June 30, 2012, shows that the agency made 24 new investments totalling NZ$21.5 million during the year, of which 14 were for newly-funded medicines and 10 for wider access to already-funded treatments. 

Significant new investments during the year included:
- Boehringer Ingelheim's Pradaxa (dabigatran) for the treatment of atrial fibrillation;
- Genentech's Pulmozyme (dornase alpha), widening access to this treatment for cystic fibrosis;
- Pfizer's Enbrel (etanercept) and Abbott's Humira (adalimumab), widening access to these autoimmune condition treatments so they can be funded to treat psoriatic arthritis (they are also funded for other forms of arthritis);
- GlaxoSmithKline (GSK)'s Tykerb/Tyverb (lapatinib), a newly-funded treatment for late-stage breast cancer;
- GSK's Votrient (pazopanib), a new-generation treatment for late-stage kidney cancer;

- Eli Lilly/Daiichi Sankyo's Effient (prasugrel), a new treatment available to patients with heart conditions who are allergic to the standard blood-thinner clopidogrel;

- Eli Lilly's Evista (raloxifene), newly-funded for osteoporosis;
- Roche's MabThera/Rituxan (rituximab), widening access to this hospital treatment for autoimmune conditions; and

- Eli Lilly's Forteo (teriparatide), newly-funded for osteoporosis.

"We expect an additional 56,840 patients to benefit from these decisions in a full year, over and above those patients already receiving funded medicines. During the year, 3.3 million New Zealanders received funded medicines, the highest number yet," writes PHARMAC chair Stuart McLauchlan in the annual report.

He also notes that the agency is "moving smoothly" to integrate hospital medicines into its core work.

"We reached a small milestone with an agreement to list parecoxib injections (Dynastat) for the short-term management of surgical pain. The agreement with Pfizer includes a 33% price reduction, and savings to District Hospital Board hospitals of around NZ$1 million over five years," he writes.