Where we dispel some misunderstandings about what PHARMAC does and how we do it.
Truth: The people who work at PHARMAC want all New Zealanders to live longer, healthier, happier lives. We care about money only because we have a limited budget which we need to manage carefully.
In 2019/20, we managed $1.04 billion in spending on medicines. We invested all of it into medicines for New Zealanders.
Truth: 3.74 million people receive funded medicines each year. 10% of those people account for 84% of the spending on medicines.
These are expensive medicines to treat conditions such as autoimmune conditions, cancer and hepatitis C.
Over time, the percentage of funds used by the top 10% of people is increasing. 6 years ago 10% of people accounted for 79% of spending.
Truth: Medicines might be ‘available’ in other countries, but it doesn’t mean they are Government funded.
In New Zealand, if a medicine is funded, generally 100% of its cost is covered by the government.
On average in the OECD, governments and compulsory insurance only covered 58% of community medicine costs. Most of the rest is coming out of patients’ pockets.
In Germany and France, government and compulsory health insurance cover 80% or more of medicine costs. By contrast, in Latvia, Poland and Lithuania, almost two-thirds of medicine spending was paid by patients.
Truth: On a straight numbers basis, the Australian government does list a few more medicines and related products than New Zealand (about 100).
However, Australians pay more for each prescription, up to AU$41. Most New Zealanders only pay $5. In New Zealand, you do not have to pay the co-payment after you’ve received 20 prescriptions in a year. This means your medicine is likely to be free after you’ve paid $100 each year. In Australia, the cap is closer to $1500.
While no system is perfect, the New Zealand model means cost is less of a barrier for people to access the medicines they need.
Unlike New Zealand, Australia does not have a fixed budget for medicines.
Myth: Because PHARMAC gives suppliers sole access to the New Zealand market, we are more likely to have stock issues.
Truth: New Zealand has fewer stock issues than Australia in general. When we give suppliers sole access to the funded market, we also make them responsible for ensuring that medicine is available. There can be financial penalties for suppliers who fail to keep medicines in stock.
In 2020, both New Zealand and Australia have had more stock issues than normal. The COVID-19 pandemic has made transport more challenging and affected many manufacturing plants.
The contracts we have with suppliers has meant we have had fewer issues reach consumers. Generally, we have been able to find replacements for medicines with a supply issue.
The above claim has been made in the media but, in fact, we listed 14 new medicines and widened access to another 32. Six were new cancer medicines that treat lung cancer, leukaemia, ovarian cancer and breast cancer. Two new medicines were for rare diseases, a rare form of cystic fibrosis and severe haemophilia A.
Every year, we increase the number of funded medicines available to improve the health outcomes of New Zealanders.
Truth: PHARMAC doesn’t buy medicines. We just decide which ones the government will pay for. Pharmacies buy medicines from suppliers and pharmaceutical companies. The Ministry of Health then reimburses pharmacies at the rate we agreed with the pharmaceutical company.
The only exception to this is vaccines (except the influenza vaccine).
Truth: We are committed to funding medicines that are proven to make a difference for people. Price is not the only issue with many new medicines. Our clinical advisers tell us whether any new medicine has the evidence to back up the claims made by pharmaceutical companies.
PHARMAC moved quickly to fund PrEP and Maviret. These are truly lifesaving and life-changing medicines. PrEP prevents the spread of HIV and Maviret is a cure for hepatitis C.
In 2019/20 we funded 14 new medicines and widened access to 32 other medicines. Six of the 14 new medicines were cancer medicines.
An estimated 71,245 more people benefited from our 2019/20 funding decisions.
Truth: When negotiating with pharmaceutical companies, we consider a range of factors. Price is one of these. However, we also look at things like taste, packaging and a medicine’s overall impact on the health sector. For example, how do people take it? Is it a pill or do they need to see a nurse or doctor?
We have the Tender Medical Evaluation Subcommittee. It is made up of GPs, pharmacists, nurses and other experts. As part of the tender process, they examine every brand of medicine that might be funded. They check the taste, the feel, how easy it is to get into the package.
The annual tender is one way that we get better prices for medicines.
Truth: Funded medicines must be approved by Medsafe. If we fund a ‘generic’ brand, it is as safe and effective as the original medicine.
Some medicines are very complex. There can even be differences between batches made by the same company. Always talk to a health professional if you notice side effects from any medicine.