Pharmac’s decision to fund limited access to two new drugs used to treat type 2 diabetes could result in up to 140,000 people dropping out with the condition, a doctor says.
Photo: LDR / Steve Forbes
The Chairman of the Diabetes Foundation Aotearoa, Dr. John Baker said that needs to change, highlighting the flaws in the state Medicines Agency’s funding model.
His comments follow the release of documents Pharmac released under the Official Information Act on its decision late last year to fund empagliflozin and dulaglutide, as well as feedback from people in the healthcare sector.
Unlike existing treatments for people with type 2 diabetes, which focus on lowering a patient’s blood sugar levels, the two drugs can also help a person delay other related complications, such as kidney and heart disease.
The agency announced in December that it would start funding medication for 53,000 patients with the disease who meet certain criteria starting in February.
But according to Pharmac’s own papers last year, 195,000 people nationwide are taking drugs for the disease. And with 45,266 people in South Auckland with diabetes alone, Dr. Baker that this created an ethical dilemma for specialists like him.
“Who is missing out on this and how do you as a doctor make this decision?”
Pharmac said its role is to get the best health outcomes on a tight budget and it has received significant feedback from health professionals who support its approach to the drugs.
Diabetes is the country’s largest and fastest growing health disease, and South Auckland is home to the highest number of people diagnosed in New Zealand.
The Department of Health estimates that there are 263,938 people with the disease in New Zealand, and it is more common among Māori, Pacific and South Asians.
According to Pharmac, the gross cost of funding the two drugs was estimated at $ 125 million over five years.
“The harsh reality, and the fundamental reason why Pharmac exists, is to control costs,” said Dr. Baker.
He said that while a parliamentary review of Pharmac’s work was ongoing, the investigation would not address the agency’s budget.
Baker said Pharmac’s focus should be on prevention, not cost savings.
“The thing about these two drugs, empagliflozin and dulaglutide, is that they are the first to affect outcomes like death, heart disease and kidney failure,” he said.
“This is how the US Food and Drug Administration (FDA) sees it today with drug registration. It looks at hard results.”
However, he said Pharmac was obsessed with the numbers, which was reflected in the documents released under the Official Information Act on the decision-making process for the two drugs.
“It was more concerned about whether it would be on budget.”
Social costs not taken into account – criticism
Patient Voice Aotearoa spokesman Malcolm Mulholland said he was aware of the criticism made by Pharmac regarding the introduction of empagliflozin and dulaglutide.
“We know Pharmac has rationed, especially those two drugs. And in the end, Pharmac doesn’t have the money to fund the treatment of the other 140,000 people.”
The group acts as an advocate for people with serious illnesses and has criticized Pharmac for a number of its funding decisions.
“Part of the problem with Pharmac is that the people who make the decisions are supposed to be the experts, but they’re also the bean counters,” Mulholland said. “And they don’t seem to be calculating the social cost of their decisions.”
Pharmacy faces “difficult decisions”
Pharmac Director of Operations Lisa Williams said that during the consultation process on funding the two diabetes medicines, it had received significant feedback from health professionals who supported its approach.
“Pharmac’s role is to get the best health outcomes on our fixed budget. If you’re on a tight budget, there will always be more drugs than we can afford, which means we’ll have to make some tough decisions. “
Williams said expanding access to other people who would benefit from the new drugs is something to do when funds are available.
“Pharmac will continue to make the best decisions possible and expand the treatments available to all New Zealanders based on a robust, evidence-based approach, just as we have done for the past 27 years.”
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