A thematic analysis of recent PHARMAC new medicines' subsidy decisions
PHARMAC, the Pharmaceutical Management Agency, manages the Pharmaceutical Schedule on behalf of the Government. The Agency is tasked with securing the best health outcomes that are reasonably achievable from pharmaceutical treatment and from within the amount of funding provided (§ 47 NZPHD Act, 2000). The Agency reports that it continues to improve New Zealanders’ access to funded medicines. In determining which pharmaceuticals to fund, PHARMAC’s Operating Policies and Procedures (OPPs) state that nine criteria guide its decision- making. The OPPs further state that PHARMAC can apply whatever weight it sees fit to the application of these criteria. I undertook a thematic analysis of 20 cases referred by PHARMAC’s principal medical advisory body, the Pharmacology and Therapeutic Advisory Committee (PTAC), to PHARMAC during the period February 2004 to November 2006 to determine whether these criteria were acknowledged in the official minutes of the respective bodies. PTAC is similarly required to take account of the abiding decision criteria. I also sought to determine whether other factors were apparent in guiding the decisions. There was evidence that PHARMAC consistently applied the decision criteria. PTAC was less assiduous in recording its application. In addition, I found that PHARMAC takes account of factors outside the stated criteria. I noted that PHARMAC takes particular account of the degree to which a decision might be publicly, politically or medically contentious in its decision-making. I also found evidence that consistency with prior decisions is another factor which PHARMAC takes into account, though does not apply routinely. This research indicates that PHARMAC does take account of its abiding decision criteria, applying health needs as well as fiscal criteria, though the weighting given each criterion is nowhere apparent in its official minutes. There remains an opportunity for evaluative research to determine whether fiscal considerations ‘outweigh’ needs considerations in PHARMACs decision-making.