The unified national Hospital Medicines List has now taken effect in New Zealand, ensuring consistent access for patients, but taking away District Health Board autonomy and ensuring only one avenue for reimbursement. Separately, July's updates to the pharmaceutical schedule include a first listing for AstraZeneca (UK)'s anti-platelet Brilinta (ticagrelor).
IHS Global Insight perspective | |
Significance | The Hospital Medicines List (HML) took effect from 1 July and addresses "postcode prescribing", whereby some drugs were available through some District Health Boards (DHBs) but not others. |
Implications | Separately, included in the Pharmaceutical Schedule listings for July was AstraZeneca (UK)'s Brilinta (ticagrelor), funded for 12 months rather than six following a confidential rebate arrangement. |
Outlook | The HML, although ostensibly improving patient access, also removes DHBs' autonomy and therefore toughens what is already one of the world's most draconian reimbursement environments. |
New Zealand's medicines reimbursement body Pharmac has completed work on compiling the national Hospital Medicines List (HML), which took full effect from 1 July. The list standardises the drugs that can be prescribed to patients across all District Health Board (DHB) hospitals in the country, and has been drawn up following a 2010 Ministerial Review Group request.
The HML, which takes the place of Section H drugs on the Pharmaceutical Schedule, is ostensibly designed to avoid the problem of "postcode prescribing", whereby patients prescribed a certain drug in one DHB would be unable to obtain that drug in another DHB. Examples cited by Pharmac include infliximab (Remicade; Johnson & Johnson, US) for inflammatory bowel disease and other conditions, and ranibizumab (Lucentis; Novartis, Switzerland) for macular degeneration, which are now uniformly available across the country. Doctors wishing to prescribe a drug not included on the HML can apply to Pharmac for an exception, and in cases of clinical emergencies there are rules in place to allow DHBs to make the decision independently.
Pharmac is also working to ensure that the HML is harmonised with the community drug list, so that patients discharged from hospitals are able to easily continue treatment with funded medicines, and the national list will ease this process.
For a link to Pharmac's landing page for the HML, which includes links to the list itself and the consultation process behind its formulation, see here.
Brilinta among July additions to the schedule
Separately, AstraZeneca (UK)'s anti-platelet drug Brilinta (ticagrelor; also marketed as Brilique in the EU) has been included on the Pharmaceutical Schedule for reimbursement, also from 1 July. Indicated as a treatment for acute coronary syndrome (ACS), Brilinta will be made available alongside standard treatment clopidogrel plus aspirin, for patients who have had particular types of heart attack – ST-elevation myocardial infarctions (STEMI), and non ST-elevation myocardial infarctions (NSTEMI). Funding is provided for 12 months of treatment, rather than the six months initially proposed, made possible by a pricing arrangement with AstraZeneca – the UK firm will be rebating some of Pharmac's costs back to the New Zealand government under a confidential agreement. Pharmac expects funding of the drug to cost NZD14.3 million (USD11.08 million) per year.
Other schedule changes effected from 1 July include:
- Neulasta (pegfilgrastim; 6mg per 0.6ml syringe): Amgen (US)'s sustained-duration neutropaenia treatment given a full reimbursement listing subject to Special Authority criteria for patients undergoing chemotherapy.
- Risedronate: Sandoz (subsidiary of Novartis, Switzerland)'s 35mg tablets given full funding.
- Humira (adalimumab; AbbVie, US): granted new listing for 20mg per 0.4ml prefilled syringe. The Special Authority criteria are also extended to include patients with juvenile idiopathic arthritis and fistulising Crohn's disease.
For a link to Pharmac's July Pharmaceutical Schedule, see here.
Outlook and implications
Although Pharmac's chief executive, Steffan Crausaz, states that the primary aim of the HML is to ensure nationally consistent access, he also admits that savings are likely to occur. The unified list in effect takes away DHB autonomy and increases the power of Pharmac, in what is already a notoriously difficult national reimbursement environment.
The schedule listing for Brilinta follows nearly a year-and-a-half after Australian authorities decided to reimburse the drug in February 2012. The drug gaining reimbursement at all reflects Pharmac's view of its life-saving effects over clopidogrel: AstraZeneca applied for funding on the basis of data from the PLATO trial, which showed after 12 months treatment that the composite rate of vascular death, heart attack, and stroke was significantly lower in ticagrelor than clopidogrel (9.8% versus 11.7%). Heart disease is one of New Zealand's leading causes of death, with higher incidence among Maori and Pacific Islands men in particular. Details of the deal reached between Pharmac and AstraZeneca to ensure that funding for 12 months was deemed cost-effective have not been released. The ability to fund the drug for 12 months, rather than the six months initially deemed cost-effective by the Pharmacology and Therapeutics Advisory Committee, will benefit 3,300 patients during the first year, and up to 12,200 people by the fifth year.
Related articles
- New Zealand: 26 April 2013: New Zealand's PHARMAC releases four more DHB drug list therapeutic groups
- New Zealand: 1 April 2013: New Zealand's Pharmac seeks feedback on proposed Brilinta listing
- New Zealand: 6 February 2013: New Zealand's PHARMAC moves towards national hospital drug lists with approval of two therapeutic areas
- New Zealand: 8 August 2012: PHARMAC Proposes Dedicated Hospital Drug List