Actioning the medicines strategy

• Abstract
• Characteristics of this policy
• Purpose and process analysis
• Expected outcome
• References

Abstract

In December 2007, the Minister of Health released a high-level national medicines strategy and accompanying action plan for New Zealand. The broad objectives of this strategy are to implement processes that secure quality, access and optimal use of medicines. Significant progress has been achieved on the first Action Plan. Details of the Plan have therefore now been reviewed and updated.

Recent developments

In New Zealand, decisions about which medicines should be publicly funded and what price should be paid are made by a government agency, PHARMAC. In 2007, following extensive consultation, the government released a strategic framework entitled 'Medicines New Zealand' (Ministry of Health 2007a) together with an accompanying action plan, 'Actioning Medicines New Zealand' (Ministry of Health 2007b). The strategy aimed to support the medicines system to deliver:

• Quality safe and effective medicines;
• Equitable and affordable access;
• Optimal use of medicines resulting in optimal health outcomes.

The focus of the Action Plan was on the processes used by PHARMAC and other key stakeholders in securing medicines for New Zealanders. The Ministry of Health has reported a number of achievements since the first Action Plan, including:

• Improving the transparency of PHARMAC's processes, for example, by inviting applicants for medicines' subsidies to meet with PHARMAC at the beginning of the funding application process and by holding Stakeholder Forums for people with an interest in PHARMAC's work to give advice on how this work can be improved;
• Extending the NZ$3 co-payment for prescription charges to prescriptions written in public hospitals for people moving from secondary health care services back into the community;
• Developing an ongoing work programme for realising the potential of the pharmacy workforce to achieve optimal use of medicines;
• Establishing an independent panel to provide advice on practical ways to improve access to high-cost, highly specialised medicines;
• Making a decision to extend PHARMAC's role into hospital medicines and a limited range of medical devices, subject to further consultation with clinicians (see also report "Extending the role of PHARMAC");
• Improving the process by which PHARMAC and DHBs develop a proposed budget for Community Pharmaceuticals with the 2009/10 budget being explicitly underpinned by an agreed set of principles.

In the light of these achievements, the Action Plan has been revised (Ministry of Health 2010). The priority areas for action will now be:

• Making changes to medicines legislation and regulations to ensure that the medicines regulatory framework provides adequate protection to consumers of medicines while facilitating access to new medicines;
• Progressing the work programme for realising the potential of the pharmacist workforce;
• Considering improvements to PHARMAC's consumer engagement processes;
• Better communicating the process for setting the Community Pharmaceuticals budget and exploring whether the budget parameters are optimal;
• Implementing the decision to extend PHARMAC's role to hospital medicines and possibly also medical devices;
• Further considering processes for improving access to high-cost, highly specialised medicines;
• Continuing to move towards a New Zealand Medicines Formulary, by launching the Universal List of Medicines and developing clinical reference information on medicines.

Degree of Innovation	traditional		innovative
Degree of Controversy	consensual		highly controversial
Structural or Systemic Impact	marginal		fundamental
Public Visibility	very low		very high
Transferability	strongly system-dependent		system-neutral
current    previous

This policy combines a range of different actions. It is therefore difficult to generalise about some of its characteristics. For example, while some aspects are quite innovative, other parts of the plan will simply make marginal changes to existing practice. Similarly, while some components of the plan would be transferable to other systems, the parts that concern PHARMAC are probably system-specific. Few parts of the plan are controversial and there is unlikely to be any major systemic impact.

Purpose and process analysis

Current Process Stages

	Idea	Pilot	Policy Paper	Legislation	Implementation	Evaluation	Change
Implemented in this survey?

Initiators of idea/main actors

• Government

• Payers

• Patients, Consumers

• Civil Society

Stakeholder positions

Submissions about the original plan to develop a national medicines strategy overwhelmingly supported the idea, especially the need to improve the transparency, flexibility and responsiveness of PHARMAC. Given that various action points to achieve these objectives have now been implemented as planned, there is no reason to believe that the views of stakeholders have changed since 2007.

Actors and positions

Government
Ministry of Health	very supportive		strongly opposed
Payers
DHBs	very supportive		strongly opposed
Patients, Consumers
Consumer groups	very supportive		strongly opposed
Civil Society
PHARMAC	very supportive		strongly opposed
current    previous

Influences in policy making and legislation

A key part of the Action Plan will be to make the necessary legislative changes to the Medicines Act 1981. Prior to making any changes, the Ministry of Health is consulting with key stakeholders to determine what changes need to be made in order to:

• regulate all medicines in a way appropriate to their risk profile
• address sustainability and capacity issues
• improve child safety provisions in medicines packaging and labelling
• improve timeliness.

Changes to the legislation are likely to include an expansion of prescribing rights such as:

• giving nurse practitioners and optometrists the same prescribing rights (within their scope of practice) as currently available to medical practitioners, dentists and midwives.
• creating a new class of prescriber called a 'collaborative prescriber'. Collaborative prescribing is a mechanism to allow non-prescribing practitioners, such as registered nurses, to prescribe medicines under the direct authorisation of a medical practitioner, dentist or midwife.

Actors and influence

Government
Ministry of Health	very strong		none
Payers
DHBs	very strong		none
Patients, Consumers
Consumer groups	very strong		none
Civil Society
PHARMAC	very strong		none
current    previous

Positions and Influences at a glance

Adoption and implementation

Both the Ministry of Health and PHARMAC have been active in implementing proposals in the first Action Plan and both parties will continue to lead the actions necessary for implementing this updated Plan.

Monitoring and evaluation

The Ministry of Health reported that "signficant progress" was made on the first Action Plan. The Ministry will continue to monitor implementation of the updated Plan and will report annually on progress.

Expected outcome

Impact of this policy

Quality of Health Care Services	marginal		fundamental
Level of Equity	system less equitable		system more equitable
Cost Efficiency	very low		very high
current    previous

This policy includes a range of different strategies which are likely to have some impact on quality, equity and efficiency in the use of medicines. For example, quality and safety should be improved by updating the regulatory regime; equity of access should be improved as decision-making becomes more transparent and by extending prescribing rights to a wider range of providers, and cost efficiency will be improved if a more optimal use of medicines can be achieved.

References

Sources of Information

• Lisa Walton. Medicines strategy. Health Policy Monitor, April 2008. www.hpm.org/survey/nz/a11/3   
• Associate Minister of Health, Minister of Health. Medicines New Zealand: Contributing to Good Health Outcomes for All New Zealanders. Wellington: Ministry of Health, 2007a. www.moh.govt.nz/moh.nsf/indexmh/medicines-nz  
• Associate Minister of Health, Minister of Health. Actioning Medicines NewZealand. Wellington: Ministry of Health, 2007b. www.moh.govt.nz/moh.nsf/indexmh/actioning-medicines-nz  
• Ministry of Health. Actioning Medicines New Zealand 2010. April 2010. www.moh.govt.nz/moh.nsf/pagesmh/7234/$File/actioning-medsnz-updated-mar2010.pdf  

Reform formerly reported in

Medicines strategy Process Stages: Policy Paper

Author/s and/or contributors to this survey

Toni Ashton

Suggested citation for this online article

Toni Ashton. "Actioning the medicines strategy". Health Policy Monitor, October 2010. Available at http://www.hpm.org/survey/nz/a16/1