Future Medicines Policy Summit 29 May

Associate Health Minister Peter Dunne on developing a national medicines strategy

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Thank-you for inviting me to comment on the development of the New Zealand Medicines Strategy. I am pleased to be able to share my thoughts on this important and timely initiative; and hope to engage with you all further as it unfolds over the coming months.

I am going to comment on two issues:

What the strategy is covering

And why I have initiated the work.

I released the terms of reference for the strategy in April. They set out the three high level areas that the strategy will cover. That is:

Access to medicines - The need to prioritise access to medicines will always be a feature of our health sector and ensuring that we continue to have purchasing systems that serve us well is a key part of the strategy. New Zealand established Pharmac 13 years ago, and in doing so has been a world-leader in having a robust system for assessing which medicines should be publicly-funded and in different approaches to medicines purchasing

But times change, especially as the range of preparations increases, and public demands and expectations also increase. It is timely to review our approach, which is what the national medicines strategy is about. Let me be clear, however, this is not a review of Pharmac. I am wanting to examine how prioritisation decisions are made now and how they should be made in the future, particularly as new, high-cost, and innovative products come available. In that context, it will be important to consider the role Pharmac and other agencies will play in the future.

Quality - Ensuring that the medicines available in New Zealand are of high quality is central to achieving good health outcomes. Medsafe is the government regulator that is responsible for controlling the quality and safety of products that are on the market. Others, such as health practitioners, are responsible for overseeing quality as medicines progress through the system.

Rational use - the irrational use of medicines may unnecessarily prolong or even cause ill-health, and wastes resources. Ensuring the rational use of medicines is closely tied with quality initiatives.

In looking at these areas I have signalled three issues that are of particular interest:

How we make prioritisation decisions;

Access to new, innovative and high-cost medicines; and

How pharmaceutical budgets are set.

Under each of the themes of access, quality and rational use I am aware that there are a number of initiatives that are underway, or where robust thinking has recently been done. I hasten to add that I am not seeking to change things that are working well, or to re-do work that has been thoroughly done. However I do think that the time has come to bring the system together under an overarching strategic framework. A framework that sets the direction for the future, that enables us to see where things are not working well now and to make improvements now and in the future.

So, now that I've set out what we are doing, I'd like to explain why.

The overall aim for the strategy is to identify where improvements can be made within the existing systems and broad policy settings to ensure the best health and disability support outcomes from medicines over the coming years. In doing so, we will need to think about the health and support needs of New Zealanders of different ethnic groups, in rural and urban settings, and of different incomes.

I am embarking on the development of the Medicines Strategy because there is a changing landscape for medicines use across the health system. There is always a lot of focus on access to medicines and particularly the role of Pharmac, but throughout the medicines-use chain there have been changes.

Along with changes come concerns and the risk that the system gets out of alignment.

For example: there are an increasing number of high-cost medicines coming through the system and this looks set to continue. These medicines may have the ability to improve health, or provide relief for people, however these benefits come at a considerable cost. We need to look at whether the systems we have used in the past to determine whether a medicine should be funded are the right systems for assessing these new medicines, or do we need to change our approach. Recent high profile cases have asked the question of how adequate our existing mechanisms are to meet these challenges.

We also need to ensure that people understand how these funding decisions are made and have confidence that the system is fair - even if they don't like the decision. We must never forget that all health decisions are ultimately rationing decisions.

Looking at how we make prioritisation decisions about individual medicines raises the issue of how we set the pharmaceutical budget. The Medicines Strategy will look at how pharmaceutical budgets are set.

Other changes that impact on our ability to get the best health outcomes from medicines are:

At the point of entry to the market, the Government has proposed changes to New Zealand's approach to regulating for the safety of medicines. While the establishment of the Australia New Zealand Therapeutic Products Authority is yet to be debated by Parliament, changes are needed to our regulatory system to ensure that in the future we continue to have the capacity to regulate for the safety of therapeutic products and to ensure the timely assessment of products.

The roles of health practitioners are changing. New Zealand had a big change with the passage of the Health Practitioners Competence Assurance Act in 2003, this Act provides the opportunity for health practitioners to work more flexibly. Increased flexibility combined with the extension of prescribing rights provides a real opportunity for more innovative services delivery.

The structures of the health system have also changed, and in particular the place of Primary Health Organisations in delivering low-cost access to primary health care services. The structure of PHOs is designed to make better use of the different skills of health practitioners by delivering care through PHO teams. I've recently been hearing about the ways that we can use pharmacists more flexibly in primary care - both to deliver medicines management services and to reduce the impact of adverse events from medicines use.

These health systems changes are happening in the context of broader societal shifts, especially an increase in the volume of information about both products and the self-management of illness that is available, and in the expectations of consumers about what should be available and when. These types of changes have flow-on implications for access, quality and safety issues.

I trust I've given you a sense of what the strategy will cover and why. I also need to say that I'm not proposing to turn the system on its head - I am not seeking to change systems that are working well, or where robust thinking has recently been done - I am looking to ensure that our systems will support good health and disability support outcomes in years to come and encourage you to consider where our system can be improved, gain efficiencies and be altered to ensure that New Zealanders continue to have strong systems into the future.

Since embarking on this work I have interacted with many sector stakeholders and I'm encouraged that, across the system, there is a shared acceptance that it is timely to look at how our system will deliver good outcomes from medicines into the future; and a wish to do that work in a cooperative and collaborative way.

I want that spirit of goodwill to carry on as we develop the strategy and grapple with the tricky issues that will arise.

ENDS

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