2 July 2024
Paul Shelton
Via email:
[FYI request #27360 email]
Tēnā koe Paul
Request for information: Factors for funding decisions
Thank you for your request dated 24 June 2024 under the Of icial Information Act 1982 (the
Act) for information relating to factors for funding decisions. You requested:
When making the decision to fund or not fund a drug and/or treatment, do you
consider potential lost time from work?
The framework that Pharmac uses for funding decisions is known as the “Factors for
Consideration”. There are four broad considerations. They are:
• Need,
• Health Benefits,
• Suitability; and
• Costs & Savings.
There are three different aspects to each factor:
• The individual,
• The family, whānau and society; and
• The health system.
You can find more information about the Factors for Consideration at:
•
https:/ pharmac.govt.nz/medicine-funding-and-supply/the-funding-process/policies-
manuals-and-processes/factors-for-consideration
•
https:/ pharmac.govt.nz/medicine-funding-and-supply/the-funding-process/policies-
manuals-and-processes/factors-for-consideration/supporting-information-for-the-
factors-for-consideration
Pharmac takes a health system perspective when undertaking assessments. That means we
account for costs and savings to the health system but not beyond that. The reason for this,
as stated in our health economics guidelines, the
Prescription for Pharmacoeconomic
Analysis, is that our statutory objective binds us to achieve “the best health outcomes” “for
eligible people” and to do so “within the funding provided.”
What this means in practice is that Pharmac does not account for indirect costs to patients,
such as the cost of patient or caregiver time off work (i.e., lost wages) and reduced
productivity costs. Please note that Pharmac is currently reviewing its PFPA and, as part of
this, its economic perspective (considering which costs and benefits are considered).
2023-24-232; A1804443
We trust that this information answers your queries. Please note, you have the right to make
a complaint to the Ombudsman about our response to your OIA, under section 28(3) of the
OIA. Details of
how to make a complaint are on the Ombudsman’s website.
To make information more freely available, we publish selected OIA responses (excluding
personal details) on our website. Please get in touch with us if you have any questions about
this.
Nāku noa, nā
Oliver Whitehead
Team Leader, Government Services
2023-24-232; A1804443
qA69689
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