THE PAEDIATRIC SOCIETY
OF NEW ZEALAND
Secretariat:
Email:
Denise Tringham
P O Box 22 234
Wellington 6441
Tel:
(04) 938 4827
Fax: (04) 976 4827
psnz@paradise.net.nz
1 April, 2010
PHARMAC_consultation@moh.govt.nz
Re: Consultation/discussion document for possible expansion of PHARMAC’s role
From the Pharmacy and therapeutics committee of the Paediatric Society of New Zealand
Thank you for the opportunity to provide feedback on this document.
27a. - We endorse the proposal that a fixed budget is set for hospital medicines providing this budget is
reviewed regularly. The requirements of each DHB will differ, therefore PHARMAC will need to
negotiate with each DHB to individualise these budgets.
With regards to medical devices - A more complete list of proposed medical devices that PHARMAC
wishes to involve itself with is needed. Some devices are highly specialised (e.g. non invasive ventilation
equipment, endoscopes, solid organ biopsy needles, peritoneal dialysis equipment are only some
examples that tertiary paediatric services must have access to for their complex patients. Senior
clinicians from services that utilise these devices must have the opportunity to select the most
appropriate devices for their patients without external pressure being applied.
There are some major disadvantages of PHARMAC’’s involvement of the controlling the purchase of
medical devices:
1) removing the clinician from important decisions on appropriateness of a selecting a certain
device
2) slowness at which PHARMAC responds to requests for assessment and access to new devices
3) inadequate clinical expertise on current PHARMAC committees to access medical devices …
Which hospital medicines will PHARMAC be interested in? Only the high cost drugs such as biological
agents, immunosuppressants,
Will this reduce the choice of hospital clinicians to prescribe what is appropriate for their patients?
27b. - Clinical choice of hospital medicines, with national consistency, will work provided the appropriate
clinical groups are given authority to set the requirements for those medicines. Paediatricians and
pharmacists working with children at secondary care centres should be involved in the medicine
requirements for these children. For tertiary centres, where children are often treated for more complex
clinical conditions, the medicine requirements should be decided by a panel of specialised paediatricians
and paediatric pharmacists involved with the care of these children. The Paediatric Society should be
consulted for representation on these panels.
27c. - A EC scheme is necessary to gain access to those medicines not covered under the hospital
schedule. The scheme must be efficient, easy to use and provide responses in a timely manner; the
DHBs should be consulted on the implementation of the scheme. Access to new therapies must be
included in the proposal. Pharmac needs to be aware that a considerable amount of time involving
medical and pharmacy staff is spent collating information and evidence to support an application. Often
there is limited evidence available for paediatric sub-specialty medicine as compared to adult medicine.
Randomised controlled trials and other clinical studies are often not possible in the paediatric population
resulting in many clinical decisions being based on clinical experience and case reports. Therefore, the
“Health of our children: Wealth of our nation”
Re: Consultation/discussion document for possible expansion of PHARMAC’s role
clinical opinion of the paediatric sub-specialist is the most relevant form of evidence. The current EC scheme
needs to be adapted to allow for this disparity and improve efficacy with the application process. Before any
change is made to the existing EC scheme PHARMAC and Medsafe need to consult key clinicians and
pharmacists with regards to the inclusion of certain highly specialised medicines on the hospital schedule.
27e. - Paediatric cancer medicines are not currently managed in the same way as adult cancer medicines.
When a paediatric cancer medicine is prescribed notification is made to Pharmac to allocate an EC claim
number. Pharmac do not currently restrict the use of cancer medicines for paediatric use in New Zealand.
Paediatric haematology and oncology patients are prescribed cancer medicines according to international
protocols and advice. Any restrictions to cancer medicines in children on clinical trial protocols could cause
delay in treatment, violation of the study protocol and potential harm to the patient.
The same concept should apply to all paediatric sub-specialties with regards to the prescription of highly
specialised medicines.
The lesson from PHARMAC’s expansion into the management of hospital cancer medicines is that prescribing in
paediatrics is entirely different from prescribing in adults and should be addressed before expanding into all
hospital medicines.
This submission prepared by members of the Pharmacy and Therapeutics Committee of the Paediatric Society
of New Zealand: Dr Rosemary Marks and Dr William Wong, Andrew Sutton Caroline De Luca, Brenda Hughes,
Kirsten Simonsen and Dianne Wright. 25 March 2010.