Pharmac ripe for reassessment

Questions of transparency and equity of outcomes are also on the agenda. Justifiably so.

The drug-buying agency Pharmac has long been, simultaneously, a good thing in itself and a focus for angry and heartbroken reproach. In some measure, that’s unavoidable. The agency decides what lifesaving and lifetransforming drugs are to be supplied – and denied – to New Zealanders. People suffer and die when it makes bad calls. Also when it makes good ones. Such is the cruelty of prioritising under a fixed budget.

Even so, the more educated, disciplined, resourced and adroit Pharmac is, the greater the wellbeing of the nation. The capacity to identify the very best bang for the buck, and negotiate well to receive it, is essential.

Cries for a reassessment of its operation have rightly been heeded by Health Minister Andrew Little and the Government, not simply because of the size and volume of the chorus of complaints, but the extent to which they seem to harmonise. The central questions for the newly announced independent review panel are how Pharmac performs against its objectives, and whether those objectives are themselves all they should be.

So far, so obvious.

But given that there’s particular doubt about whether, compared to other jurisdictions, Pharmac has been sluggish to react to new treatments, it’s a tad counterintuitive that the panel has been instructed not to consider whether past decisions were appropriate.

A directive not to drill into ‘‘specific commercial decisions’’ might be defensible on the basis that the complexities of each case have the potential to paralyse, rather than inform, the progress of the review as a whole.

But the flipside danger, no less concerning, is that determining not to get all forensic about the details of such decisions might lead to shallower assessments, making it harder to draw all the lessons that are gettable.

In this respect the review panel will themselves need to be nimble and incisive. And perhaps cry foul if their task is bedevilled as a result.

Questions of transparency and equity of outcomes are also on the agenda. Justifiably so.

Rarity that it is on the international scene, Pharmac was well-conceived from its outset and can be said to have performed well for a long time.

The wisdom of keeping its educated, disciplined professionals independent from the dabblings of politicians has long been accepted, though it’s still quite properly the Government that determines the overall budget under which Pharmac operates.

The adequacy of that budget is not on the examination table. Not for this exercise, anyway.

It’s an agreeable thought that Pharmac has the wattage and ability to rebuff the self-serving pressures of a targeted advertising campaign by a drug company, which can bedazzle the politician and layperson alike. Not so agreeable when new drugs have achieved the status and effectiveness of proven performers in other countries, while we’re still receiving yesterday’s treatments.

That really is one of the key issues for the panel chaired by consumer advocate Sue Chetwin; the lamentation that faced with an ever-widening array of what lobby group Patient Voice Aotearoa calls ‘‘more tailored, biologically nuanced, immensely sophisticated drugs that are incredibly effective for particular groups of people’’, Pharmac hasn’t been keeping up.

Whether or not this is the reality, it is most certainly a case to be answered.