Pharmac review: Māori, Pasifika and disabled disadvantaged by medicine-buying agency

Brett Holdcroft, 11, has cystic fibrosis. He wants Pharmac to fund a drug, so he can live longer and be a cardiologist. (Video first published May 2021)

Pharmac’s medicine-buying strategy appears to disadvantage Māori, Pasifika, disabled people and those with rare disorders and may have an “excessive focus on containing costs”, a major review has found.

An interim report by the Pharmac Review, released on Thursday afternoon, is the first independent review since the agency was set up more than 25 years ago.

The agency has faced regular and ongoing criticism from patients and clinicians over its decision-making processes. New Zealand spends less per capita on medicines than other comparable countries, but has worse access to the latest medicines.

Panelists were asked to consider how well Pharmac performed against what it was asked to do and whether it could be improved; timeliness of decision-making; transparency; and equity of outcomes, particularly for Māori, Pacific people, disabled people, and those with rare disorders.

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Sue Chetwin chairs Pharmac’s review panel (file photo).
Ross Giblin/Stuff
Sue Chetwin chairs Pharmac’s review panel (file photo).

Review chair Sue Chetwin said Pharmac was “underperforming in helping to remove inequitable health outcomes”.

“Its prioritisation approach appears to disadvantage Māori, Pacific people, disabled people and those with rare disorders,” Chetwin, the former chief executive of Consumer New Zealand, said.

Other key issues raised were “an excessive focus on containing costs – and a concern the cost-saving model may not be the right one to meet future health needs”.

Te Tiriti o Waitangi principles were “largely unseen in decision-making processes” and its deicision-making process was opqaue and perceived to be slow.

Its convoluted processes put off pharmaceutical companies, and it needed to engage with consumers and patient advocacy groups in a more meaningful way. There was also a perception that New Zealand was falling behind other developed countries in its access to medicines.

Pharmac also lacked fair representation of Māori, Pacific people and disabled people in its own staff, the report said.

Pharmac has come under scrutiny for its decision-making processes over the type of medicines it funds (file photo).
Mika Baumeister/Unsplash
Pharmac has come under scrutiny for its decision-making processes over the type of medicines it funds (file photo).

“Pharmac has made various commitments to improving equitable outcomes for Māori and Pacific people and disabled people, but it is a long way from achieving this goal, just as it is a long way from having a fair representation of Māori and Pacific people and disabled people within its own ranks, or systems, processes and structures that facilitate equitable outcomes.”

Panelists included health economist and governance expert Heather Simpson, corporate governance and public law consultant Frank McLaughlin, pharmacist prescriber Leanne Te Karu, GP and Otago University associate professor Sue Crengle and disability advocate and epidemiologist Dr Tristram Ingham.

Health Minister Andrew Little said the system was set up nearly three decades ago and was the envy of the world.

“But it’s sensible to look at how well it is doing the job we want it to do,” he said. “I particularly note the review panel’s comments about equity and transparency.”

Pharmac chief executive Sarah Fitt said the agency was listening and already working on many of the points raised.

“We accept there is more we need to do to uphold Te Tiriti and integrate equity in all areas of our work. This is a challenge across the health sector but is incredibly important,” she said.

It was working to make processes “faster and clearer” but often couldn’t share much information because of commercial sensitivity. It also had to work within a fixed budget which led to “difficult decisions on which medicines to fund”.

“What we are striving for is that people understand the decisions we make and have confidence we are making the best decisions,” she said.

The final report, due February 28, will include recommendations.