Access to medicines
Medications are important in the treatment of all forms of arthritis. Medicines assist people with:
- Managing symptoms – particularly pain
- Preventing damage to joints
- Maintaining joint function
Access to medicines is a subject that promotes debate and media coverage in New Zealand. Arthritis New Zealand is not seeking fundamental change to New Zealand’s system for purchasing of medicines, but we do argue for additional funding for PHARMAC. There is a backlog of medicines for arthritis that are recommended for funding but are not currently funded by PHARMAC. We would like to see this list cleared and additional funding made available in its annual budget.
During the 1980’s drug costs were going up rapidly so in 1993 the Government established the Pharmaceutical Management Agency (PHARMAC) to ensure best value for money for purchase of medicines and medical devices in New Zealand. PHARMAC’s role is to make decisions about which medicines are funded by the Government and to use its budget to subsidise medicines. It negotiates good prices for medications by dealing directly with large companies and where possible leveraging price benefits from competition and multi-product agreements.
Expert clinicians from the Pharmacology and Therapeutics Advisory Committee (PTAC) advise PHARMAC on medicines for purchase and their priority for funding.
Medicines New Zealand is a membership organisation representing the pharmaceutical industry in New Zealand. It aims to improve public funding of medicines and believes that New Zealand’s budget for medicines is too small. According to Medicines New Zealand patients in New Zealand are not getting the best possible access to medicines.
The first line of treatment for the type of arthritis where there is an immune system issue is Disease-Modifying Antirheumatic Drugs (DMARDs). These are used to suppress the immune system when it is attacking healthy joints.
Research into treatments for this type of arthritis shows that early DMARD treatment produces the best possible disease outcomes. DMARDs can delay damage to the joints to such an extent that a person given the same doses later in the course of the disease will not see similar benefits.
Access to DMARDs is not a problem in New Zealand as these medicines are publicly funded. Access is more likely to be in relation to the time it takes to get an appointment with a rheumatologist to prescribe them.
A newer type of medicine, that is, biologics, are prescribed when other medicines are ineffective.
What is a biologic?
A biologic, is any pharmaceutical product manufactured in, extracted from, or semi-synthesized from biological sources. They (or their components) are isolated from living sources—human, animal, plant, fungal, or microbial. Biological products include vaccines, blood and blood components, allergenics, gene therapy, and therapeutic proteins. Biologics belong to the cutting-edge of biomedical research and may in time, treat a variety of illnesses that have no other treatments available.
Biologics are relevant in treatments for juvenile idiopathic arthritis (JIA), rheumatoid arthritis (RA), ankylosing spondylitis (AS) and psoriatic arthritis (PsA) These drugs can assist people to achieve remission or a state of low disease activity. RA and AS in particular, can be treated using biologics.
The medicines waiting list has identified three new biologic medications for inflammatory arthritis and one nonsteroidal anti-inflammatory drug (NSAID) for osteoarthritis, that the Pharmacology and Therapeutics Advisory Committee (PTAC) have recommended be publicly funded but are not yet funded by PHARMAC.
Medicines recommended for funding but not publicly funded as at September 2019:
|Product||Indication||New listing or wider access||Year first positive recommendation made||Recommendation||Waiting period (years)|
|Golimumab||Second-line TNF-inhibitor treatment of rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis||New||May-2010||Only if cost-neutral||9,17|
|Secukinumab||Ankylosing spondylitis 2nd line||New||Feb-2018||Medium||1,41|
|Secukinumab||Psoriatic arthritis 1st line||New||Feb-2018||Medium||1,41|
|Secukinumab||Psoriatic arthritis 2nd line||New||Feb-2018||Medium||1,41|
|TNF alpha inhibitors*||Undifferentiated spondyloarthritis||Wider||Feb-2015||High||4,41|
|TNF alpha inhibitors*||Inflammatory bowel disease associated with arthritis (IBD-A)||Wider||Feb-2014||Low||5,41|
Biologic medicines are shaded in green. Source: Medicines New Zealand
*TNF alpha inhibitors recommended: adalimumab, etanercept, infliximab
*Topical NSAID recommended: Diclofenac
Note: the expression “new listing” means the medicine has not previously been recommended for funding. “Wider” means that it has been recommended previously for another condition.
Access to Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) for osteoarthritis
These medicines reduce inflammation and therefore pain for people with osteoarthritis. NSAIDs in tablet form are publicly funded in New Zealand but not topical (ointment) NSAIDs. Topical medicine is useful for people that cannot take NSAIDs internally. One topical NSAID called Diclofenac (sold under the trade name Voltaren Gel among others) has been recommended for public funding by PTAC but is not yet funded. For some New Zealanders the cost of 100 grams of ointment is not a barrier, but for others it is.
Spend to Save
In summary, early treatment can provide substantial improvement in a patient’s quality of life. While we acknowledge the cost of new medications, particularly biologics, we believe that not funding them sufficiently adds cost in other areas including;
· Increased hospitalisations
· Reduced ability to work with the subsequent need for benefits, and
· An increased need for carer support.
Arthritis New Zealand advocates for clearing medicines for arthritis on the PTAC waiting list and increased funding for PHARMAC. These are important steps to improve access to effective medicines for people with arthritis.