Source: PHARMAC
Pharmac is proposing changes to bring greater transparency and clarity to how medicine funding applications are managed on the Options for Investment (OFI) list.
The approach would allow Pharmac to decline applications that have remained in the lowest-ranked group for more than two years – helping people better understand which medicines are unlikely to be funded and why.
“The OFI list was designed to show which medicines we would consider for funding if our budget allowed,” says Pharmac’s Director Pharmaceuticals, Adrienne Martin. “But some applications have stayed on the list for years, ranked low and therefore unlikely to be funded.
“This isn’t because they’re not important, but because other applications have been assessed as higher priority. In some cases, we’ve funded newer and more effective medicines for the same condition, yet the original application remains on the OFI list.
“We’re proposing a change to make our intentions clearer and provide more clarity for people and clinicians.”
The OFI list includes medicines that have been assessed and recommended for funding by Pharmac’s advisory committees. Applications are ranked using the Factors for Consideration framework, which balances clinical evidence, health need, suitability, and cost-effectiveness.
Under the proposal:
- Applications in the lowest-ranked group for more than two years would be declined.
- This would apply to the bottom 20% of applications (if there are more than 100), or the bottom 10% (if fewer than 100).
Declined applications could be reconsidered if new evidence becomes available or the price of the medicine changes. Pharmac cannot disclose where medicines are ranked on the OFI, as it is commercially sensitive.
“We’ve heard from people living with health conditions, and the clinicians who support them, that the OFI list can feel frustrating and uncertain,” says Martin. “People want clarity – even if a medicine won’t be funded – so they can plan accordingly.”
Pharmac is committed to consultation and will not decline any applications without hearing from the public.
“We understand these decisions have a real impact,” says Martin. “That’s why we’re committed to listening before making any changes. We want to be open and honest – even when the decisions are difficult – so people and clinicians can make informed choices.”
Consultation is open until Monday 17 November. Feedback can be sent to: applicationfeedback@pharmac.govt.nz
