31 March 2021: OIA response | Data and documents concerning medicines funding costs and decisions

31 March 2021 

Dear [name and contact details withheld]

REQUEST FOR INFORMATION

Thank you again for your request dated 9 February 2021 under the Official Information Act 1982 (OIA) for information concerning PHARMAC medicines funding and funding decisions. We appreciate your patience while we consult about the release of the items requested.

You requested:

  • Any BIMS prepared by Pharmac for the incoming minister prepared since 2017
  • A list of the twenty most-expensive drugs (ranked by total spent divided by number of patients treated - please include both these numbers in your response) funded by Pharmac in the most recent financial year for which information is available.
  • Any written documents (excluding emails, but including - but not limited to memos, aide memoir and briefings) prepared for the CEO or for the minister responsible concerning any funding decision for the medicine commonly known Keytruda since 2016.
  • Any written documents (excluding emails, but including - but not limited to memos, aide memoir and briefings) prepared by officials for the CEO or for the minister responsible concerning any funding decision for the medicine commonly known as Trikafta since 2018.
  • Any written documents (excluding emails, but including - but not limited to memos, aide memoir and briefings) prepared by officials for the CEO or for the minister responsible concerning any funding decisions for Hepatitis C treatments commonly known as Maviret, Viekia Pak and Harvoni since 2015.

Per our telephone conversation on the morning of Thursday 25 March 2021, we advised we should be able to provide a response to your request by early this week. Our response to your request is below.

Briefings to Incoming Ministers (BIMs)

Further to our response to you on 9 March 2021, we are now able to release the Briefing to the Incoming Minister July 2020.

Please find the BIM included with this response (Appendix 1).

Top twenty most expensive medicines

We have provided a table of the twenty most expensive chemicals, ranked in order of total gross spend divided by number of people treated in the 2019/20 financial year below (PHARMAC's financial year runs from 1 July to 30 June).

Please note:

  1. This data was extracted in March 2021.
  2. The data provided includes chemicals dispensed through the Community schedule or through Exceptional Circumstances only. Chemicals dispensed through the Hospital schedule have not been included in this data.
  3. All costs reported are excluding GST.
  4. We have not provided the chemical name, annual gross cost, or the exact number of patients, where 10 or fewer people received the chemical as we believe this is necessary to protect the privacy of these people (section 9(2)(a) of the OIA). This is the approach we have taken to the issue of confidentiality following discussion with you.
  5. The average cost per person may not be representative of the full treatment cost per person as values provided are based on dispensings during the 2019/20 financial year up to 30 June 2020 only (eg some chemicals only became funded/available part way through the reported financial year).

An Excel view of the Pharmaceutical Schedule(external link) with medicine price and subsidy information can be downloaded from the PHARMAC website: www.pharmac.govt.nz > Pharmaceutical Schedule > Schedule resources > Community (Section B) > Quick links 

Table: Top 20 most expensive chemicals in FYR 2020, ordered by average cost per person

Category

Chemical name

Gross annual cost

Number of people

Average cost per person

Blood and blood forming organs

 

 

≤10

$439,113

Rare disorder

 

 

≤10

$414,747

Rare disorder

 

 

≤10

$219,460

Rare disorder

Taliglucerase alfa

$3,038,048

16

$189,878

Paediatric cancer therapy

 

 

≤10

$173,458

Rare disorder

 

 

≤10

$147,072

Hormone preparation

 

 

≤10

$143,081

Respiratory system and allergies

Ivacaftor

$2,836,856

28

$101,316

Cancer

 

 

≤10

$86,157

Other cytotoxic agents

 

 

≤10

$84,465

Rare disorder

 

 

≤10

$76,750

Immunosuppressants

Pembrolizumab

$42,163,775

588

$71,707

Rare disorder

 

 

≤10

$66,726

Monoclonal antibodies

 

 

≤10

$64,921

Intravenous administration

Total parenteral nutrition (TPN)

$4,850,031

77

$62,987

Cancer

Nivolumab

$1,108,757

19

$58,356

Paediatric cancer therapy

 

 

≤10

$57,435

Cancer

 

 

≤10

$56,915

Paediatric cancer therapy

 

 

≤10

$56,486

Rare disorder

 

 

≤10

$52,466

Written documents prepared for the CEO or for the minister responsible

PHARMAC does not hold any documents prepared for the Minister or the CEO concerning funding decisions for the medicines you identified. PHARMAC does not prepare documents for Ministers regarding medicines funding decisions, although we occasionally provide ‘no surprises’ emails to the Minister’s office. In general, documents for medicines funding decisions are sent to the PHARMAC Board or its delegate.

We have decided to provide you with documents prepared for the PHARMAC Board and/or its delegate as we do not hold any documents matching your request.

Additionally, we have interpreted your request to mean funding decisions concerning the Pharmaceutical Schedule (Schedule) and not for individual patient funding applications via our Exceptional Circumstances Framework (eg applications submitted via the Named Patient Pharmaceutical Assessment). We have not provided any documents related to funding decisions made via our Exceptional Circumstances Framework as we have considered this out of scope of your request.

Documents concerning funding decisions for pembrolizumab (Keytruda)

In June 2016, PHARMAC announced a decision to fund pembrolizumab (Keytruda) for the treatment of unresectable or metastatic melanoma

We have decided to release (with some redactions) the Memorandum for Board meeting 29 July 2016 and Minutes of the PHARMAC Board meeting 29 July 2016 to you in response to your request for copies of documents concerning funding decisions for pembrolizumab. 

Please note, we require a small amount of additional time to finalise these documents for release under the OIA. We will provide these documents to you as soon as possible and without undue delay. 

Additionally, PHARMAC has several open funding applications for Keytruda currently under consideration for the treatment of various indications. No funding decisions have been made for these applications yet and so no documents concerning funding decisions for these applications currently exist. 

A list of the funding applications received for Keytruda(external link) and progress details of the applications can be found in the PHARMAC Application Tracker: https://connect.pharmac.govt.nz/apptracker/s/(external link)

Documents concerning funding decisions for Trikafta

PHARMAC has not received any funding applications for Trikafta and we have not made any decisions concerning the funding of Trikafta. 

We have not provided any documents for this request as we do not hold any documents concerning funding decisions for Trikafta. 

Documents concerning funding decisions for Hepatitis C treatments (Maviret, Viekira Pak and Harvoni)

In June 2016, PHARMAC announced a decision to fund ledipasvir with sofosbuvir (Harvoni) and paritaprevir with ritonavir and ombitasvir with dasabuvir +/- ribavirin (Viekira Pak) for the treatment of chronic hepatitis C. Subsequently, in June 2017, PHARMAC announced a decision to widen access to Harvoni.

 

In December 2018, PHARMAC announced a decision to fund glecaprevir and pibrentasvir (Maviret) and change the listing terms for Viekira Pak.

We have decided to release the below documents (with some redactions) in response to your request for copies of documents concerning funding decisions for Hepatitis C treatments Maviret, Harvoni and Viekira Pak.

  • Memorandum for Board meeting 8 June 2016
  • Minutes of the PHARMAC Board teleconference meeting 8 June 2016
  • Memorandum for consideration by the Director of Operations under delegated authority May 2017
  • PHARMAC minute of the Director of Operations decision under delegated authority June 2017
  • Memorandum for Board teleconference meeting of 13 December 2018
  • Minutes of the PHARMAC Board meeting by teleconference December 2018 

Please note, we require a small amount of additional time to finalise these documents for release under the OIA. We will provide these documents to you as soon as possible and without undue delay. 

Release of information under the OIA

Please note that PHARMAC approaches its assessment of requests for information under the OIA on the basis that, once released, the information becomes publicly available - in other words once we release the information to you it becomes available to any other party in that exact form (whether by you distributing it to others or by virtue of us receiving the same request from a different third party). 

We have withheld or not provided a small amount of information within the BIM and top 20 chemicals data where we consider this is necessary to protect the privacy of natural persons (section 9(2)(a)). 

As required under the OIA, we also considered whether, in the circumstances, the withholding of this information was outweighed by other considerations which render it desirable, in the public interest, to make this information available. In this case we did not consider that the public interest outweighed the reasons for withholding the information. 

Please note you have the right, by way of complaint under section 28(3) of the OIA to an Ombudsman, to seek an investigation and review of our decision. 

We trust that this information answers your queries. We are making our information more freely available, so we will now publish selected OIA responses (excluding personal details) on our website. Please get in touch with us if you have any questions about this. 

Yours sincerely 

Rachel Read
Manager, Policy and Government Services