1. PHARMAC’s Regional Forum Otahuhu: 14 September 2011 Rotorua: 28 September 2011 Christchurch: 4 October 2011 Taupo: 11 October 2011 North Shore: 12 October 2011 Porirua: 25 October 2011

2. Agenda Welcome Introduction to PHARMAC Connecting and communicating with health consumers Review of Te Whaioranga PHARMAC’s Pacific Responsiveness Strategy Q&A session Wrap up

3. Pharmaceutical Management Agency How medicines are funded in New Zealand

4. What is PHARMAC? Set up in 1993 to manage public spending on prescription medicines PHARMAC legislative objective: To secure for eligible people in need of pharmaceuticals the best health outcomes that are reasonably achievable from pharmaceutical treatment and from within the amount of funding provided.

5. Annual health budget – almost $14 billion (determined by the Minister of Health) PHARMAC’s budget Community and cancer medicines managed by PHARMAC and paid by DHBs - $777 million (determined by the Minister of Health) DPF Managed and paid by PHARMAC 1-2% of pharmaceutical budget.

6. What do we do? Manage the Pharmaceutical Schedule The subsidy for each item on the list (not the price) Conditions of use (to access subsidy) Help hospitals manage pharmaceutical spending Manage special access programmes (Panels, Exceptional Circumstances)

7. Patient Our place in the health sector

8. Prescriber Patient Our place in the health sector

9. Prescriber Patient Our place in the health sector

10. PrescriberPharmacist Patient Our place in the health sector

11. Co-payment PrescriberPharmacist Full price Patient Our place in the health sector

12. PrescriberPharmacist Pharmaceutical companies Full price Patient Our place in the health sector Co-payment

13. PrescriberPharmacist Pharmaceutical companies Patient Our place in the health sector Co-payment 20% Full price

14. PrescriberPharmacist Pharmaceutical companies Patient Our place in the health sector Co-payment 20% 80% Full price

15. Funding Decisions Is there a reason to fund this medicine? Safer or more effective alternative? More cost effective than alternatives? Are there sufficient funds? Is this the best way to spend the money we have? Economic assessments are conducted in-house. PTAC (Pharmacology & Therapeutics Advisory Committee) and its subcommittees provide independent clinical advice to PHARMAC. PHARMAC Board (or staff under delegation) make all funding decisions. Medicine supplier Medsafe Public consultation PHARMAC PTAC PHARMAC Board PTAC

16. PHARMAC Decision Criteria 1. Health needs of eligible people 2. Health needs of Māori and Pacific peoples 3. Availability and suitability of existing pharmaceuticals and other therapies 4. Clinical benefits and risks 5. Cost effectiveness (compared to purchasing other health care and disability services) 6. Overall budgetary impact (both pharmaceutical and total health budget) 7. Direct cost to health service users 8. Government priorities for health funding/Government objectives 9. Other criteria (with appropriate consultation)

17. We also promote the responsible use of medicines Encourage responsible use – Access and Optimal Use Team Help to implement major decisions affecting many people Special Foods Contract with external parties for supply of education programs and resources for GPs BPAC Promote PHARMAC at conferences Develop and supply resources for consumers Gout “Practical tips for giving medicine to kids” Resources, including in a variety of languages, can be ordered free from www.pharmaconline.co.nz www.pharmaconline.co.nz

18. What we don’t do Buy and/or sell drugs (pharmaceutical suppliers, wholesalers, pharmacies) Make or store drugs (pharmaceutical manufacturers and wholesalers) Write out cheques for drugs supplied to patients (DHBs) Set budget (Minister) Approve drugs for use in New Zealand (Medsafe)

19. Consumer Advisory Committee Advises PHARMAC with input from a consumer or patient point of view Helps PHARMAC establish relationships with consumers, better communicate with consumers and ensure consumer perspectives taken into account Regional Forums Currently 9 members from various consumer health sectors across the country Not intended to be representative of all consumers Visit http://www.pharmac.govt.nz/CAC http://www.pharmac.govt.nz/CAC Medicine supplier Medsafe Public consultation PHARMAC PTAC PHARMAC Board PTAC

20. Challenges We have a fixed budget and could never fund all the medicines available for all people (unique to New Zealand) A fixed budget requires prioritisation of medicines spending Conflicting pressures come from advocacy groups, clinician groups, media, patients, pharmacists and pharmaceutical companies Whatever we do we will never please everyone, but we do need to have a system that is robust and regarded as fair

21. Questions?

22. Connecting and communicating with health consumers

23. Information and services What kinds of medicines information and services do you need? What kind of information and services would you like to get from PHARMAC? Could these services be delivered on line? What do you expect to do or find online?

24. Discussion and questions

25. PHARMAC’s Māori Responsiveness Strategy Action Plan

26. Te Tiriti o Waitangi Principles  Partnership  Protection  Participation

27. Goal To ensure that Māori have:  Access to subsidised medicines  The knowledge to use these medicines safely and appropriately

28. History of the Māori Responsiveness Strategy 2001: 15 consultation hui 2002: Māori Responsiveness Strategy I 2007-2012: Māori Responsiveness Strategy II 2012-2017: Māori Responsiveness Strategy III

29.  “there are barriers to accessing health professionals – cost, attitude to Māori, being treated as a number”  “patients are not provided with sufficient information from chemists”  “you aren’t told everything and you can’t ask what you don’t know”  “chemist labels are confusing and hide the contents of the medicine”  “Confusion around trade names versus generic medicines”  “Medications need to be explained”  “Print on small bottles are too little to read”  “Kaumatua do not like to ask questions and are sometimes treated like they are thick”  “Māori are unsure of medicines – there is an air of mistrust and often they just need understanding” PHARMAC survey Key points from hui

30. Māori Responsiveness Strategy – Māori strategic priorities – Internal capability – Data collection and analysis – Funding and procurement – Information on subsidised medicines and optimal use – Māori representation and participation

31. PHARMAC commitment to Māori Health

32. www.hrphow.co.nz

33. He Manawa Tahi Koiora Tini Cardiovascular Disease – key priority Tane Ora – Māori and Pacific Island men 35+ years Māori and Pacific Island men die of heart disease, 10-14 years earlier than non-Māori and non-Pacific Island men www.oneheartmanylives.co.nz

34. Asthma is the leading cause of childhood admissions to hospital Māori and Pacific people are more likely to be hospitalised for asthma and have more severe chronic symptons The ratio of SABA to ICS dispensings is higher in Māori and Pacific children www.spacetobreathe.co.nz

35. http://www.iwiora.co.nz/feedback He Wā Pātai / Whakawhiti Kōrero hoki

36. Discussion

37. PHARMAC’s Pacific Responsiveness Strategy

38. The Pacific Strategy Informing development of the Pacific Responsiveness Strategy: 2006 – informal advisory group of Pacific health stakeholders Stocktake Improve capability Raise awareness of PHARMAC’s role in Pacific health Develop and strengthen relationships Formalise a strategy Strong CAC support and input.

39. The Pacific Strategy Māori and Pacific health needs are decision criterion 2. Pacific peoples are a significant population in NZ and face some significant health disparities and barriers. Focuses efforts on: Developing an understanding of Pacific health issues Building networks and relationships Targeting AOU campaigns Connecting to broader government and health sector initiatives

40. Your input What are the major issues for Pacific peoples with regards to medicines? How can PHARMAC help to address these issues? How can PHARMAC best connect and communicate with Pacific leaders and health workers in your community? And more…

41. Discussion

42. Thank you for attending the PHARMAC Regional Forum