New Zealanders’ Access To Licensed And Subsidised Medicines Compared With A Nationwide Single Payer System In Each of Australia, The United Kingdom And The United States
Introduction: There is disagreement about whether New Zealand is falling behind in access to medicines compared to countries such as Australia (1, 2). The controversy has largely focused around the subsidy (public funding) of medicines by New Zealand’s single payer public health system, and in particular the role of the New Zealand Pharmaceutical Management Agency (PHARMAC) (3-6). Aims: To compare New Zealanders’ access to licensed and subsidised medicines with that under a nationwide, publically funded single payer system in each of Australia, the United Kingdom and the United States. Methods: A literature search was performed for previous international comparisons of access to medicines in the peer-reviewed literature. The search found a lack of established methods for large-scale comparisons between high-income countries. Therefore a new methodology was developed that classified all medicines licensed and subsidised under the four single payer systems using active agents and the World Health Organization’s Anatomical Therapeutic Chemical (ATC) system, and matched medicines to registration dates from the regulatory authorities in New Zealand, Australia, the United Kingdom and the United States. Three linked investigations were performed. Investigation One compared the number, type, timeliness and innovation of medicines licensed for adults and subsidised under the four single payer systems. Investigation Two compared the number, type, timeliness, lowest age authorised and suitability of formulation of medicines licensed for children and subsidised under the four single payer systems. Investigation Three examined key informants’ perceptions of New Zealanders’ access to medicines, including in comparison to the other countries studied. Results: Investigation One found that New Zealand had fewer licensed and subsidised entities, licensed and subsidised fewer innovative entities that provided important health gains, and had older licensed and subsidised entities than the comparator countries. Investigation Two found that while New Zealand licensed the second lowest number of entities in children, PHARMAC subsidised the second highest number of entities. PHARMAC also subsidised the second highest number of entities in formulations suitable for children. New Zealand also had the highest ratio of medicines licensed in children to those licensed in adults, and the highest ratio of medicines subsidised in children to those subsidised in adults. Investigation Three found that key informants perceived New Zealand to have an effective medicines licensing system that ensured the safety and efficacy of medicines, and which ensured a good relationship with the pharmaceutical industry while remaining objective. PHARMAC was perceived to control pharmaceutical spending, be able to extract the maximum buying power from a limited budget, and to be resistant to lobbying or political influence. However, there were concerns over access to new medicines, and that medicines were assessed more stringently for cost effectiveness than other health investments. Conclusion: New Zealand was perceived to have an effective system for licensing medicines, and contain pharmaceutical spending well. New Zealand compares well in children’s access to medicines, but adults may not have the same access to newly developed and innovative medicines as patients in Australia, the United Kingdom and the United States. Further work is needed to determine what if any impact this has on health outcomes.
Advisor: Norris, Pauline; Tordoff, June; Reith, David
Degree Name: Doctor of Philosophy
Degree Discipline: School of Pharmacy
Publisher: University of Otago
Keywords: New Zealand; Australia; The United Kingdom; UK; England; The United States; US; USA; PHARMAC; Pharmaceutical Benefits Scheme; PBS; National Health Service; Department of Veterans Affairs; Department of Veterans Affairs National Formulary; VANF; Pharmaceuticals; Medicines; Single Payer; Licensing; Subsidy; Public Funding; Access to Medicines; Children's Medicines
Research Type: Thesis