Enhanced assessment and decision-making
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What we are aiming for
We want to ensure that we make high-quality, evidence-based and timely funding decisions that achieve the best possible health outcomes, including improved health equity. We need clear and consistent processes for assessment and decision-making, including clarity of how equity considerations are embedded throughout our work. This will involve enhancing assessment methods, increased transparency, having stronger partnerships with Māori, better collaboration with the health and disability system, enhancing input from a more diverse range of stakeholders, learning from people with lived experience, and sharing more impactful and accessible information about our decisions.
Where we’re currently at
We have had a programme of work since 2018 to increase transparency and, while ensuring robustness of our decisions, make our funding assessment and decision-making processes faster, clearer and simpler. Progress has been made, however we are still focussed on continuous improvement.
Key initiatives over the last 12 months to make improvements have included:
- Publication of our prioritisation lists to be more transparent about what medicines we are considering to fund
- Improvements to our funding assessment and decision-making processes
- Strengthening how the needs and interests of Māori are factored into our assessment and prioritisation work
- Developing frameworks for and implementing funding criteria that promote equity of access to medicines (discussed more in the equity-related theme)
- Measuring and publishing the timeliness of our assessment (time-to-rank) and decision‑making (time-to-fund)
- Introduction of principal supply status when funding medicines (replacing sole supply) to provide greater flexibility to fund alternative medicines for those who may experience, or are at heightened risk of, adverse clinical outcomes due to a brand change.
Actions and initiatives underway or commencing in 2022/23
To continue our progress during 2022/23 we will:
- Make effective use of the funding uplift provided in Budget 2022 to fund both more treatments and widen access to already funded treatments
- Commence COVID-19 vaccine purchasing and management
- Continue to secure COVID-19 treatments
- Progress two process improvement projects to improve how we (i) conduct initial assessments of funding applications to improve timeliness; and (ii) improve processes for seeking and receiving expert advice
- Explore how we present our advisory committee meeting records using our decision-making framework (the Factors for Consideration) to make it clearer how the Factors have been applied
- Clarify information published about our exceptional circumstances framework around its application to people with rare disorders, and publish better information about the outcomes from our exceptional circumstances decisions
- Prioritise engagement with our Rare Disorders Specialist Advisory Committee (meeting as soon as practical) and proactively seek new funding applications from suppliers of medicines for rare disorders
- Explore with Te Whatu Ora, Te Aka Whai Ora and Manatū Hauora the best way for sector views to be taken into account in our assessment of funding applications
- Continue to improve the usability of our web-based Application Tracker to support improved transparency.
Further work and considerations for our full response in October 2022
What we consider when making decisions – and how we demonstrate that
Pharmac applies its ‘Factors for Consideration’ when making funding decisions. These are the considerations – within a framework – that New Zealanders have previously told us we should apply when making decisions. The review raised questions, having heard stakeholder concerns, about whether Pharmac is considering the right factors and explaining how they are applied in our decisions. We will consider how best to respond to this challenge.
The Factors for Consideration were last reviewed in 2016. Given significant system changes and the importance of requirements and expectations under Pae Ora, we need to review them. This would be a significant undertaking that requires specific resource, including to ensure effective engagement with all stakeholders. We are also looking to release summarised information about our assessment of funding applications, which would also require resource.
Medicines for rare disorders
We agree with the Review that more can be done to improve the lives of people with rare disorders. We look forward to working with Manatū Hauora as it develops a rare disorders strategy – this is important work to set an overall direction for the system’s focus on rare disorders and better connect roles and work. At the right time, to ensure good connection with the strategy work, we will review of our exceptional circumstances policy.
Our assessment methodologies for consideration of funding applications
We heard from the review that we need to do better to develop clear and consistent practices in our work, including our methodologies, processes and documentation. We will continue to explore how we can improve the timeliness and efficiency of our processes and enhance our assessment methodologies, including how we better include equity considerations. Our full response in October will also outline required resourcing for this work.