How we get clinical advice into our decision-making
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PHARMAC requires good advice from clinicians to make decisions on medicines funding.
This advice is received in a number of ways, including through expert committees. PHARMAC also keeps up-to-date with the latest clinical information through ongoing professional development, monitoring of trial results and medical journal articles.
Our main clinical advice comes from an expert committee of medical practitioners, the Pharmacology and Therapeutics Advisory Committee (PTAC). PTAC has been part of the health system since the 1950s and, in 1993, began providing advice to PHARMAC.
PTAC’s role & relationship to PHARMAC
PTAC considers clinical evidence around funding applications, and takes into account PHARMAC’s Factors for Consideration before making recommendations to PHARMAC on medicines funding. The Factors for Consideration are part of PHARMAC’s Operating Policies and Procedures.
PTAC members are not employed by PHARMAC (although they are reimbursed for the time they give to serving on the committee).
The committee has 10 members who have expertise in examining clinical studies and broad experience and knowledge of medicines and the conditions they treat. PTAC meets four times a year and the Chair of PTAC attends PHARMAC Board meetings as an observer and to share PTAC’s views directly with the Board.
PTAC makes recommendations to PHARMAC to help us make decisions. PTAC operates under defined Terms of Reference which are available on our website. The Terms of Reference were reviewed in 2009, in line with a recommendation in Actioning Medicines New Zealand.
How are PTAC members appointed?
Members are appointed by the Director-General of the Ministry of Health. Membership terms are usually three years and may be renewed. The process for appointing members is explained in an Appointment Protocol, also available on our website.
What does PTAC take into account when providing advice?
PTAC applies the same decision-making framework as the PHARMAC Board when making recommendations. Some stakeholders have suggested that PTAC should focus exclusively on clinical effectiveness, since that is its major expertise. As clinicians, however, PTAC members are also concerned with, and can usefully comment on, other factors including cost and opportunity cost, health inequalities and health need.
PTAC currently has 20 subcommittees providing more specialised advice on clinical areas such as cancer, diabetes, mental health, heart health (cardiovascular), and neurology. These subcommittees are a significant resource of over 140 health professionals providing expert clinical advice to assist PHARMAC’s assessment of funding applications and answer specific questions from PHARMAC between meetings. They also help us to be aware of issues and concerns that doctors and other health professionals are dealing with. Our current subcommittees are listed on our website along with minutes.
Special access panels
Some pharmaceuticals are very expensive, and to help ensure these are appropriately targeted, PHARMAC manages panels of expert doctors to apply the Special Authority criteria on which patients can access treatments. Panels are currently maintained for:
We currently have panels for:
- Cystic Fibrosis
- Gaucher treatment
- Multiple Sclerosis treatment
- Pulmonary Arterial Hypertension
- Haemophilia treatments
- Hepatitis C treatment
- Named Patient Pharmaceutical Assessment Panel
The panels assess the clinical situations of patients seeking funded access to treatments. The treatments require patients to meet defined access criteria, and the health professionals on each panel use their expertise to assess individual applications. The Panels can also provide advice to PHARMAC and review any changes suggested to the access criteria.
Other clinical input
PHARMAC employs a number of people with clinical expertise – in medical practice, pharmacy or the science of pharmacology. A large number of PHARMAC’s staff have experience in medical or scientific fields.
The views of health professionals are an important part of our decisions on pharmaceutical funding proposals. Often clinicians can identify important clinical terms and technical adjustments that help us make better decisions. We aim to include clinicians in our consultations – in many cases meeting with them face to face – as much as possible.
Applications from health professionals
As well as providing views through formal consultation, clinicians can also bring submissions to us to have medicines funded on the Pharmaceutical Schedule. Prescribers may also make applications for a named patient under the NPPA policy for medicines that are not listed on the Pharmaceutical Schedule for their clinical circumstances.
When we receive applications from clinicians seeking funding for medicines, these are treated in the same way as applications from pharmaceutical companies, with PTAC’s advice being sought and economic analysis being undertaken for Schedule listing applications.
Named Patient Pharmaceutical Assessment (NPPA)
PHARMAC contracts with health professionals to apply criteria on applications for named patients under the NPPA policy.