Pharmac Cost Cutting Could Affect Thousands

Pharmac Cost Cutting Could Affect Thousands Of Osteoporosis Patients

Wednesday, 10 October 2007

Osteoporosis Awareness Week is nearly here but New Zealanders with osteoporosis won't have much to celebrate if PHARMAC moves patients off their current once-weekly treatment and on to an older daily treatment.

PHARMAC has issued a 'request for proposals' for the sole supply of the osteoporosis medication, alendronate, which is the most effective osteoporosis treatment available and funded in New Zealand This is currently supplied as the FOSAMAX brand which is taken once a week. Receipt of proposals closes on the last day of Osteoporosis Awareness Week, Friday 19 October 2007.

About 32,000 people will be affected if PHARMAC move funding from the current once-weekly dose of FOSAMAX to a generic formulation that needs to be taken daily. Over three quarters of these patients are above 65 years of age, and 7,000 are aged 85 or older. Nearly all will find the retrograde change less convenient and most are likely to find adhering to the new dosing regime difficult and confusing.

Executive Director of Osteoporosis New Zealand, Julia Gallagher, said "If PHARMAC opts for a generic daily tablet patients will be moved from their current once-weekly medication to a smaller dose formulation that needs to be taken every day.

This may not seem too bad until you understand that alendronate must be taken 30 minutes before the first drink, food or other medication of the day, and you have to remain upright for 30 minutes after taking it. Undertaking this regime, seven days a week, 365 days a year is a significant burden and requires a lot of perseverance. It will reduce the number of patients that continue to take the medication; many will find it too hard, and this will ultimately increase the number of fractures that occur.

We already know that poor perseverance with medication results in frequent lost opportunities to reduce the high impact of osteoporotic fractures on patients and the health system.

We believe this proposal is motivated by short term cost saving rather than patient welfare. This is difficult to justify given that PHARMAC's own figures confirm that the current funded treatment is a good investment and reduces costs for District Health Boards. These savings come from patients having fewer fractures and therefore needing less orthopaedic surgery, less rehabilitation and fewer admissions into residential and private hospital care.”

Leading medical specialists have expressed concern over the potential change and believe it will result in an increase in osteoporosis related fractures. Rheumatologist, Dr Alan Doube, said "If this change goes ahead, my concern is that the inconvenience will mean patients will find this regime too difficult and will not take their medication as required. I've no doubt that in the longer term we will see a subsequent increase in osteoporosis related fractures as a result”.

"Patients taking alendronate on a daily basis could also be exposed to an increase in side effects such as irritation of the oesophagus due to the increased exposure to alendronate,” said Dr Doube.

Auckland Endocrinologist and Chair of the Osteoporosis New Zealand Scientific Committee, Dr Brandon Orr Walker, said, "In the past, both a daily and a once-weekly medication were available and fully funded. This allowed patients to choose how often they wanted to take their medicine. It is noteworthy that well over 90 percent of patients chose a once-weekly tablet. Patient preference is definitely for a weekly regime.

This is very significant for a medicine that has rigorous requirements to achieve adequate absorption and effectiveness. If daily dosing is the only option, adherence to this administration will suffer."

Ms Gallagher commented that "If this sole-supply contract results in a daily generic formulation, New Zealand will be one of few developed countries in the world funding only a daily alendronate as a first line medication. Other comparative countries, including Australia, are funding weekly osteoporosis medications because this is what is best for patients. A move to a daily generic would be a huge step backwards for the treatment of osteoporosis in New Zealand."

Dr Orr Walker said, "The disease affects more than half of women and nearly a third of men over the age of 60 in this country and is a major cause of long-term disability and death. This is a serious disease and older people deserve the best treatment available, not the cheapest."

If people are concerned about the possible changes to osteoporosis treatment, they should contact PHARMAC or their local MP.

-ENDS-

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