Appendix 2: Guiding information for completing a funding application

On this page

Need Factor

Need quadrant	Questions to address	Additional explanation
The health need of the person	How unwell is a person with the health condition compared to an individual in perfect health? What is the morbidity and premature mortality of the condition in New Zealand?	Health need is about the disease, condition or illness. When considering how unwell the person is, think about the morbidity and mortality of the condition in the New Zealand context. See sections 5.3 and 5.3.1 of the Supplier Guidelines for further information.
The availability and suitability of existing medicines, medical devices and treatments	What options are currently funded to treat the population with this condition? How well do the current options work?	All currently funded pharmaceuticals are listed in the Pharmaceutical Schedule(external link).
The health need of others (family, whānau and wider society)	What are the health needs for the family or whānau of the person with the disease, condition or illness? And the health needs for wider society?
The impact on the Māori health areas of focus and Māori health outcomes	Has the disease, condition or illness been identified as a Māori health area of focus? What is the impact of the disease, condition or illness on Māori health outcomes?	The Māori health areas of focus are detailed in the relevant section of the Supporting Information. Te Whaioranga (PHARMAC’s Māori Responsiveness Strategy) provides more background information. Read Te Whaioranga When considering the impact of the disease, condition, or illness on Māori health outcomes, think about if there is a disparity between Māori and non-Māori. Specifically, the extent of disparity in disease prevalence and incidence (including excess QALY loss). See sections 5.3 and 6.3 of the Supplier Guidelines for further information.
The impact on the health outcomes of population groups experiencing health disparities	What is the impact of the disease, condition, or illness on other population groups already experiencing health disparities? To what extent does the disease disproportionately affect populations that have substantive health disparities compared with the rest of the New Zealand population?	When considering the impact of the disease, condition, or illness on population groups already experiencing health disparities, consider the extent of disparity in disease prevalence and incidence (including excess QALY loss). See sections 5.3 and 6.3 of the Supplier Guidelines for further information.
The impact on Government health priorities	Is the disease, condition, or illness a Government health priority?	More information on current Government priorities can be found here: Ministry of Health Statement of Intent(external link) PHARMAC accountability documents

Health Benefits Factor

Health benefits quadrant	Questions to address	Links to additional information
The health benefit to the person	What would the health benefits, or health losses, be to the person who would receive the medicine, medical device or treatment that is being proposed?	Health benefits are specifically those benefits that can be gained from the proposed pharmaceutical treatment. When considering these benefits think about: the health benefits and risks, compared with other funded interventions the absolute risk reductions (ARR) in medical events or improvement in health states any other health benefits to the person (eg evidence of improved efficacy through improved adherence)? See section 5. 8 of the Supplier Guidelines for further information
The health benefit to family, whānau and wider society	What would the health benefits be for the family or whānau of the person receiving the treatment, and for wider society?	Health benefits can sometimes be experienced by people other than the person receiving the treatment. These benefits must be able to be explicitly linked to the treatment of the person receiving the medicine or medical device.
Consequences for the health system	If the proposal was funded, what would be the consequences for the health system? Does the proposal relate to any of the Government's priorities for the health system?	Consider where a funding decision may, for example, have implications for efficiencies for the health system. These consequences are different to explicit costs and savings (considered in the costs and savings quadrant)

Health benefits quadrant

Questions to address

Links to additional information

The health benefit to the person

What would the health benefits, or health losses, be to the person who would receive the medicine, medical device or treatment that is being proposed?

Health benefits are specifically those benefits that can be gained from the proposed pharmaceutical treatment. When considering these benefits think about:

the health benefits and risks, compared with other funded interventions
the absolute risk reductions (ARR) in medical events or improvement in health states
any other health benefits to the person (eg evidence of improved efficacy through improved adherence)?

See section 5. 8 of the Supplier Guidelines for further information

The health benefit to family, whānau and wider society

What would the health benefits be for the family or whānau of the person receiving the treatment, and for wider society?

Health benefits can sometimes be experienced by people other than the person receiving the treatment. These benefits must be able to be explicitly linked to the treatment of the person receiving the medicine or medical device.

Consequences for the health system

If the proposal was funded, what would be the consequences for the health system?
Does the proposal relate to any of the Government's priorities for the health system?

Consider where a funding decision may, for example, have implications for efficiencies for the health system. These consequences are different to explicit costs and savings (considered in the costs and savings quadrant)

Costs and Savings Factor

Costs and savings quadrant	Questions to address	Links to additional information
Health-related costs and savings to the person	What would the health-related costs and savings be for the person who would be treated with the medicine or medical device that is being considered?	Costs and savings must be health-related and specifically attributable to the person receiving treatment. Consider, for example, any health-related out-of-pocket expenses that may be changed by the proposal?
Health-related costs and savings to the family, whānau and wider society	What would the health-related costs and savings be to the family or whānau of the person receiving the medicine or medical device, or to wider society?
Costs and savings to pharmaceutical expenditure	How would funding the medicine or medical device impact on pharmaceutical expenditure? Would funding this medicine or medical device result in some savings due to people switching from another pharmaceutical that is already funded?	Consider the impact specifically on the pharmaceutical budget for both the current and financial year and the effects over future years.
Costs and savings to the rest of the health system	Would the funding of the medicine or medical device create costs or savings for the rest of the health system?

Suitability Factor

Suitability quadrant	Questions to address	Links to additional information
The features of the medicine or medical device that impact on use by the person	What features of the medicine or medical device may impact use by the person receiving the medicine or medical device? Is the medicine or medical device registered for the condition that funding is being sought for?	Consider features such as size, shape, taste and methods of delivery
The features of the medicine or medical device that impact on use by family, whānau and wider society	What features of the medicine or medical device may have an impact on use by the family or whānau of the person receiving the medicine or medical device, or wider society? Are there certain features of the medicine of medical device which would impact on the health outcomes if the pharmaceutical has to be given by someone other than the patient?
The features of the medicine or medical device that impact on use by the health workforce	What features of the medicine or medical device may have an impact on use by the health workforce?