25 August 2023

Mr de Brouwer
[FYI request #23666 email]

Tēnā koe Mr de Brouwer,

On 1 August 2023,  you emailed the Ministry of Social Development (the
Ministry) requesting  information about allowable costs under a Disability
Allowance, specifically relating to medicinal cannabis products. Your request
has been considered under the Official Information Act 1982 (the Act).
Please find the Ministry’s responses to your 18 specific questions below. For
the sake of clarity, I have grouped some questions together.
1)   What criteria does a Client have to meet to get assistance via the
Disability Allowance for Medicinal Cannabis Products as an allowable cost
in their Disability Allowance?
2)    Why does MSD decline Medicinal Cannabis Products as an allowable cost
in a client's Disability Allowance? If the answer is anything related to
science and evidence please give a thorough explanation with sources in
response to Q6.
5)  When declining Medicinal Cannabis Products as an allowable cost under
the Disability Allowance is MSD responsible for explaining the reason of
the decline? If not, why not?
6)  Does MSD base their decision when granting/declining Clients who've
applied to have Medicinal Cannabis Products included in their Disability
Allowance on any evidence-based research? If so, please cite specific
examples? If not, why not? And how are decisions then made if not based
on evidence-based research?
15)  When declining assistance for Medicinal Cannabis Products under
Disability Allowance, what work is being done to ensure that the needs of
the client/patient are fully understood, heard and they have a mana
enhancing experience?
16)  Is MSD aware that declining Medicinal Cannabis Products as an allowable
cost is forcing clients/patients to go down a more harmful path that WILL
increase in cost to Government over the time the longer the patient/client
is prescribed? Dispensings for Morphine and Oxycodone increased

between 2017 and 2021 and will continue to climb. There is already a
large and growing amount of people on these types of pain medications
which will eat away at your quality of life resulting in more prescriptions
and treatments. The warnings on the labels carry risks.
Medicinal cannabis is considered under Disability Allowance by the Ministry as
a non-subsidised pharmaceutical. More information on non-subsidised
pharmaceuticals can be found here: workandincome.govt.nz/map/income-
support/extra-help/disability-allowance/non-subsidised-pharmaceuticals-
01.html.
The costs of a non-subsidised pharmaceutical can be included as an additional
expense for Disability Allowance (DA) if the client’s usual general practitioner
(GP) or nurse practitioner verifies the pharmaceutical item is essential, directly
related to the client’s disability, and there are no suitable subsidised or partly
subsidised alternatives.
The health practitioner will also need to confirm the reasons for prescribing the
pharmaceutical item, if PHARMAC funding has been applied for and declined
and the reasons for this, or the reasons PHARMAC funding has not been sought.
In New Zealand, under Section 29 of the Medicines Act 1981, a medicinal
cannabis product must be prescribed by a medical practitioner registered to
practice  in  New  Zealand.  The  Ministry  may  therefore  seek  additional
information to ensure that the prescribing practice meets these legal
requirements.
A reason for declining to include medicinal cannabis products into a DA is there
is often a fully subsidised or partly subsidised alternative treatment that hasn’t
yet  been  trialled.  As  an  example,  medicinal  cannabis  products are often
requested to help manage pain symptoms. In order for the criteria for non-
subsidised pharmaceuticals to be met, the client would need to have trialled
an  extensive  range  of  analgesics,  pain  modulating  medications  and  other
therapies that can relieve pain before we could include medicinal cannabis into
DA costs.
Please  find  the  following  links  regarding  who  can  receive  a  DA  and  the
qualifications and in the following links:
Disability Allowance: www.workandincome.govt.nz/products/a-z-
benefits/disability-allowance.html.
Qualifications: www.workandincome.govt.nz/map/income-support/extra-
help/disability-allowance/qualifications.html.
Types of costs: www.workandincome.govt.nz/map/income-support/extra-
help/disability-allowance/types-of-costs-01.html.
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Costs paid for: www.workandincome.govt.nz/map/income-support/extra-
help/disability-allowance/costs-paid-for-01.html.
Costs not included: www.workandincome.govt.nz/map/income-
support/extra-help/disability-allowance/costs-not-included-01.html.
3)  How many clients are currently in receipt of Disability Allowance
assistance that covers Medicinal Cannabis Products as an allowable cost?
4)  What percentage of applicants applying/applied for Medicinal Cannabis
Products as an allowable cost covered under the Disability Allowance are
declined or lapsed, and what is the most common reason for declining
this assistance? If you could, please separate the data between lapsed
and declined.
9)  Since the passing of the Misuse of Drugs (Medicinal Cannabis) Regulations
Act 2019, has MSD updated any of it's systems to align with current
legislation? Example: Cannabis is now classed as a Medicinal Product that
can be prescribed and therefore being updated as such on all of MSD's
software/resources/processes/tools. If not, why?
As medicinal cannabis products are classified as a non-subsidised
pharmaceutical (which was already a category) no additional changes were
required to be made to the Ministry’s systems.
I am unable to provide you with the information you have requested in
questions 3 and 4, as this information as it is held in notes on individual client
files and is not centrally reported. In order to provide you with this information,
Ministry staff would have to manually review a substantial number of files. As
such, I refuse your request under section 18(f) of the Act. The greater public
interest is in the effective and efficient administration of the public service.
I have considered whether the Ministry would be able to respond to your
request given extra time, or the ability to charge for the information requested.
I  have  concluded  that,  in  either  case,  the  Ministry’s  ability  to  undertake  its
work would still be prejudiced.
7)  Does MSD have any written or digital resource(s) or guidelines and
process' (that are not already readily available to the public, such as
internal memos, bulletins, reminders etc) regarding decision making
when granting/declining Medicinal Cannabis Products as an Allowable cost
under Disability Allowance?
If so, could you please provide it without it impacting the business? If
there is no process/resource or guide, why not and how is the decision
then made?
17)  When a Regional Health Advisor consults a Client's doctor regarding their
Medicinal Cannabis Products, what questions are being asked to formulate
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the decision to grant or decline? Why is the client/patient not consulted
with during this process? Why does it appear that the client/patient is
placed last in the factors for decision making? They are left scrambling
trying to figure out how they will manage.
Members of the Regional Health and Disability team are required to ensure
that the application meets the criteria for DA. Where additional information is
required, this information may be asked of the client (where they have the
information) or of their regular general practitioner (GP). Any questions asked
of the client’s GP to formulate this decision, relate to the criteria; for example,
ensuring that they consider this to be essential and that all other subsidised
options have been tried.
The current process is that the Case Manager requests input from the Regional
Health and/or Disability Advisors, who collate this information if it isn’t already
available. The request is then forwarded to the Principal Health Advisor (PHA)
and Principal Disability Advisor (PDA) who provide a recommendation
determining whether or not the application meets the DA criteria. Appendix A
provides the guidance table used by the Regional Health & Disability teams to
ensure they have all the necessary information before sending to the PHA and
PDA for approval.
8)  Since the passing of the Misuse of Drugs (Medicinal Cannabis) Regulations
Act 2019, has MSD delivered any education to it's Staff, Case Managers
and/or Regional Health Advisors (or anyone involved in the decision
making process) to make them aware of the changes and what that
means for clients/patients? If so, how and what was involved? If not, why
and will this change?
10)  Has MSD updated any of its processes and/or understanding around
Medicinal Cannabis Products, the prescription process and it's challenges,
in order to better service whanau across New Zealand who are now legally
prescribed it? If not, why, will this change, when? If so, how?
11)  Have staff at MSD who ultimately decide grant/decline for Medicinal
Cannabis Products received any training or extra education relating to
Medicinal Cannabis Products? If not, why?
The PHA and PDA meet frequently with the Regional Health and Disability
teams and the subject of medicinal cannabis products is regularly discussed.
Information is shared during the regular meetings and resources as they
become available. We have circulated the following pieces of guidance from
BPAC to the regional teams to assist when assessing qualification to including
medicinal cannabis products into DA entitlement. Please see the links below
for your reference:
•
bpac.org.nz/2022/medicinal-cannabis.aspx
•
www.health.govt.nz/our-work/regulation-health-and-disability-
system/medicinal-cannabis-agency/medicinal-cannabis-agency-
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information-health-professionals/medicinal-cannabis-products-meet-
minimum-quality-standard
•
www.health.govt.nz/our-work/regulation-health-and-disability-
system/medicinal-cannabis-agency/medicinal-cannabis-agency-
information-health-professionals
All frontline staff should be sending all requests to include medicinal cannabis
products  through to the RHD team, who then forward the request to the
PHA/PDA (as per our response to Q7 above).
As this is an area of medicine that is relatively new to Aotearoa, and is rapidly
changing, all requests come to the PHA or PDA for a recommendation, advice
or direction.
12)  What are MSD's policies or actions to ensure that Regional Health Advisors
have adequate medical knowledge and understanding to make medical
decisions? How often is their competency and knowledge tested, and
how? If not, why?
The RHAs as Ministry staff are required to undertake professional development
activities relevant to their position. The PDA and PHA provide ongoing
mentoring and training opportunities, meeting the wider Regional Health and
Disability teams for regular fortnightly teleconferences. The RHAs are also
responsible  for  maintaining  and  upskilling  their  own  knowledge in their
respective roles. The performance of the RHA in this role is managed by the
reporting manager through regular performance reviews.
You may also find helpful the job description for the RHA’s and the RDA’s at
the following links;
•
www.msd.govt.nz/hr/documents/position-descriptions/dce-service-
delivery/client-service-delivery/regional-health-advisor-oct-20.pdf
•
www.msd.govt.nz/hr/documents/position-descriptions/dce-service-
delivery/client-service-delivery/regional-disability-advisor-oct-20.pdf
13)   Under 'Pharmaceutical Charges' in the MSD Deskfile I have found this
statement:
"Costs not included Disability Allowance cannot be paid for:
-
pharmaceutical items not related to the client's disability (for
example a cough suppressant for the flu) or
-
illegal drugs used for medical purposes (for example marijuana for
pain relief)."
   Why has this remained as such, declaring Cannabis/Marijuana as an
ILLEGAL drug when it is not, based on the Misuse of Drugs (Medicinal
Cannabis) Regulations Act 2019?
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14)  This speaks to the above question, is it MSD's understanding that MSD
may have influenced the decision-making process by not adequately
updating its resources? If not, how has MSD made this clear for staff who
have the right to grant/decline?
Prescribed medicinal cannabis products are not illegal drugs, therefore  this
statement would not apply. As previously stated, medicinal cannabis is treated
as all other unsubsidised pharmaceuticals and there is no impact on decision
making based on applications being for medicinal cannabis.
18)  Te Pae Tawhiti talks about Mana Manaaki, Kotahitanga and Kia takatu
tatou, can you answer how MSD can meet these values if clients/patients
are being turned away from support and being put on drugs that actively
take away quality of life from them?
The Ministry reviews all applications for support based on the legislated
criteria. Where this criterion is met, DA support is provided. This is in line with
the values outlined in Te Pae Tawhiti.
If the Ministry has made a decision that you do not agree with, you are able to
request a formal review. The Review of Decision (ROD) process falls under
Section 391 of the Social Security Act. This allows for a beneficiary to exercise
their right to challenge and review any decision made by the Ministry and is an
opportunity to:
•   advise that they disagree with a specific decision made, and
•   ensure that legislation has been applied correctly, which includes the
appropriate exercise of discretion.
The Ministry’s publicly available website provides for the process for anyone
who  wishes  to  review  a  decision  Ministry  has  made,  at  this  link:
www.workandincome.govt.nz/about-work-and-income/complaints/review-of-
decisions.html.
The principles and purposes of the Official Information Act 1982 under which
you made your request are:
•
to  create  greater  openness  and  transparency  about  the  plans,  work
and activities of the Government,
•
to increase the ability of the public to participate in the making and
administration of our laws and policies and
•
to lead to greater accountability in the conduct of public affairs.
This Ministry fully supports those principles and purposes. The Ministry
therefore  intends  to  make  the  information  contained  in  this  letter  and  any
attached documents available to the wider public. The Ministry will do this by
publishing this letter on the Ministry’s website. Your personal details will be
deleted, and the Ministry will not publish any information that would identify
you as the person who requested the information.
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If you wish to discuss this response with us, please feel free to contact
[MSD request email].
If you are not satisfied with this response regarding qualification to medicinal
cannabis product, you have the right to seek an investigation and review by
the Ombudsman. Information about how to make a complaint is available at
www.ombudsman.parliament.nz or 0800 802 602.
Ngā mihi nui
Bridget Saunders
Manager
Issue Resolution

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Appendix A

The table below indicates the information required from the client’s regular GP
to process DA applications for specialist unsubsidised pharmaceuticals in order
to assess against DA criteria.
What relevant health condition(s) is this medication
being prescribed for?
Please list all previous and current therapeutic  NB: this should include
interventions that have been trialled to treat the  medications as wel  as other
interventions such as
condition(s) named above, and whether or not they  counsel ing, specialist referral
were beneficial?
etc and reason for their
cessation
What previous medication (if any) has the applicant  NB: This should include
trialled and what was their effect / impact?
alternative forms of the same
medication
Do you consider the use of this medication to be
essential in treating the conditions named above?
Will you have an ongoing role in the prescribing
and/or supervision of this medication?


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Document Outline