Funding applications declined

18 May 2020

[Name and contact details redacted] 

REQUEST FOR INFORMATION

Thank you for your email of 28 April 2020, in which you have requested:

• a list of the 50 most expensive drugs that Pharmac has refused to fund, and
• for each drug, list the name, the standard retail cost for the supplier, a short reason for why it was declined, and the number of people it was estimated could have benefited from this drug. 

In answering your request, it may be helpful if I provide an explanation of the medicines funding process.

PHARMAC’s role is to decide which medicines are publicly funded for New Zealanders.  Each year, PHARMAC receives a number of applications containing proposals for the funding of a medicine or changes to a medicine that is already funded, for example, a proposal to widen access to the medicine.

As PHARMAC must work within a fixed budget, choices need to be made about which of the proposals should be progressed to a funding decision. This involves assessing a large amount of often complex information to identify proposals that would provide the best health outcomes from within the available funding.  In deciding which proposals to fund, PHARMAC assesses each proposal against its decision-making framework, the Factors for Consideration. This includes consideration of health benefits, health need, costs and savings, and suitability. Proposals are ranked against all other potential funding options according to the Factors for Consideration. 

With a small number of exceptions, PHARMAC has not, in the past, routinely made decisions to decline funding applications.  On the whole, medicines that we have assessed for funding and that are not currently publicly funded are still active on PHARMAC’s options for investment list. The ranking of a medicine can change over time, for example, as new information about a medicine (such as new clinical evidence or a change in price) becomes available.

More recently, PHARMAC has started to make some decisions to decline older, inactive funding applications, to give people clarity about whether a medicine is, or is not, being actively considered for funding.  Following two sets of consultation, we recently notified decisions to decline a number of these older, inactive applications. Lists of these are available on our website at www.pharmac.govt.nz/news/notification-2019-07-22-inactive-applications/ and www.pharmac.govt.nz/news/notification-2020-03-20-declines/.  Information about the individual declined applications is also available from PHARMAC’s website, in the application tracker links in the notification documents. 

We are unable to provide you with the pricing of the most expensive treatments in this categories because, where pricing is provided, it is commercially sensitive, confidential and, in some instances subject to negotiation, so is being withheld under sections 9(2)(b)(ii), 9(2)(ba)(i) and 9(2)(j) of the OIA.  PHARMAC is unable to provide information on ‘retail’ price because in many cases the treatments are not available for retail sale at this time and, if they are, PHARMAC does not hold this information (section 18(g) of the OIA).  Section 18(g) also applies in respect of information about the number of people that may benefit from each of these applications, because their inactivity means that any information would no longer be current.

Another class of applications that may be relevant to your request are those that are still being considered by PHARMAC but have not yet been funded.  You can find these applications on our Application Tracker on PHARMAC’s website.

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 in respect of your request.

We trust that this information is useful.  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