Collaboration is needed with all areas of the health system to involve more stakeholders in decision making. Currently the consumer voice is only included during the end stage of the decision-making process. Many times a decision or recommendation has already been made by PTAC or PHARMAC making the consumers input irrelevant. With greater collaboration and a restructure of decision making processes patients, clinicians, district health boards, primary health organisations and pharmaceutical companies can provide more of an accurate analysis of all areas of the health system that will be impacted by a medicine funding decision.
Transparency is required within the PHARMAC system so decisions can be better understood by patients and the health system. Currently there is a system in place that gives little information about the progress of a medicine funding application. Also the public is informed about recommendations made by PTAC three months after the meeting has been held. At times the PTAC minutes aren’t very clear about specific decisions made around medicine recommendations for funding. With greater transparency more will be known about why those decisions were made and what needs to be provided/resolved before the medicine can be publicly funded.
Timeliness is a huge setback for the PHARMAC funding model. A set criteria needs to be established to improve the timeliness for patients when accessing publicly funded modern medicines. 18 months to process a medicine application and make a decision on its funding should be a sufficient amount of time to complete the overall process. A timeliness criteria will hold PHARMAC to account and will ensure that more medicines are funded for patients.
Funding PHARMAC at a more appropriate level can begin to clear the backlog of medicines that sit on the waiting list. Currently New Zealand invests 5% of the vote health budget into medicines compared to 10% in Australia and 11% in the UK. The OECD average that countries commit to their medicines budget is 18%. In "real terms", New Zealand's medicines budget as a % of vote health budget, has been decreasing since 2007 (accounting for population growth and inflation). An increase of $80 per person per year is required to get medicines funding back to the equivalent of 2007 levels. If PHARMAC directed the savings it makes back into its own combined pharmaceutical budget it would also be able to purchase more medicines for New Zealand patients.
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