Access to medication

Medications are important in the treatment of all types of arthritis. Medicines assist people with:

• Managing symptoms – particularly pain
• Preventing damage to joints
• Maintaining joint function
• Slowing disease progression

Background

During the 1980, drug costs were going up rapidly, so in 1993, the Government established the Pharmaceutical Management Agency (Pharmac) to ensure the best value for money for the purchase of medicines and medical devices in New Zealand. Pharmac’s role is to make decisions about which medicines the Government funds 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.  

Medsafe is the regulator of products used for a therapeutic purpose in New Zealand. These include medicines, medical devices, and controlled drugs used as medicines. Pharmac is the body responsible deciding which approved medicines and devices are funded in New Zealand.

Medsafe is responsible for the regulation of therapeutic in New Zealand. The process to approval includes: 

• Reviewing and evaluating clinical and manufacturing data 
• Report on safety, quality and efficacy  
• Recommendations to defer or approve

Before new and changed medicines can be marketed in NZ, approval must be obtained.  

• Consumers can look up the status of any medicine that is in the process of, or has been through, the regulation process Consumer Medicine Information and the Product/Application search
• Consumers can also find information on the rules and regulations about importing medicines here: Personal Importation of Medicines 

Pharmac manages Aotearoa New Zealand’s medicines budget. The funding process determines whether Pharmac will fund or not fund approved medications. Evaluation is based on a set of criteria that includes: 

• Need  
• Health benefits 
• Costs and savings 
• Suitability 

A supplier, health professional, or everyday New Zealander can apply to have a medicine or related product funded. Read more about the funding approvals process. 

After an application is received, Pharmac reviews and evaluates the evidence, including others' submissions on the same medicine and seeks from independent clinical experts from across New Zealand's healthcare sector who sit on Pharmacology and Therapeutic Advisory Committee (PTAC) and its subcommittees. Pharmac has a budget supplied by the government and every funding decision must be considered in relation to the amount of funding available.

After the clinical advice is assessed, a process begins that ranks medicines, high to low and creates a prioritised list of medicines. It then identifies a list of medicines to take forward to the negotiating stage. After a provisional agreement with suppliers is reached Pharmac then consults with New Zealanders.

Pharmac’s evaluations are largely limited to the cost to the health system, so any new medicine must show increased value over existing treatments.  

For very expensive arthritis medicines, for example, biologic DMARD for inflammatory arthritis, such as rheumatoid arthritis and axial spondylitis, a special authority process is the most frequently used. Usually, the published Special Authority criteria define the clinical circumstances of patients who can receive funding for the medicine. People may first be required to try a less expensive medicine, or the medicine may need to be prescribed by a particular type of health practitioner. 

Special Authority applications are processed by the Ministry of Health’s Sector Operations Group. The majority of Special Authority applications are processed electronically and are usually used while the patient is still with the prescriber.  

There is also a more restrictive Exceptional Circumstances named person application (NPPA) for medicines that are not generally available for the patient’s medical condition. 

Your rights to cost-free access to public services will depend on your citizenship/residency and immigration status. New Zealand citizens are entitled to free healthcare in the public system. New Zealand has reciprocal healthcare arrangements with several countries. These arrangements may, or may not, cover access to the rheumatology services and medications that you need. It is imperative that you have this clarified before you move. 

People who are moving to New Zealand will need to confirm how their medical condition will affect their visa eligibility and any future application for permanent residency. Your employer (if sponsored), an immigration consultant or health insurer may be able to advise. Arthritis NZ can not provide immigration advice.

Bring a supply of your medication with you in case there are delays obtaining your rheumatology appointment and authority for funding in New Zealand. A letter for immigration and customs from your prescriber will be needed. Medication must remain in the original packaging. Patients can usually bring up to a three-month supply of prescription medicine with them. Read more about travelling with medication.

If medications require refrigeration, check with the airline before you leave to ensure this can be accommodated, either in the flight fridge or an approved container and coolant with your hand luggage. Most airlines have information on their websites.

New Zealand has a mix of public and private rheumatology and orthopaedic services. Public services are available throughout the country but waiting lists can be long in some places. Private services operate in all main centres.  

A primary care physician or general practitioner (GP) generally refers patients to these services. Rheumatologists in private practice will accept referrals from GPS or medical specialists (e.g. an orthopaedic consultant or another rheumatologist). Some important points to note:

• Enrolment with a GP is important to access a full range of care, including specialist services. You will almost certainly need to have an address in New Zealand before you can enrol
• Find rheumatologists in the area where you are planning to live. Check that a referral from an overseas rheumatologist will be accepted
• If possible, before migration, organise a to have a rheumatology appointment as soon as possible after arrival in New Zealand
• Obtain your records from your current rheumatologist and discuss a way forward for treatment. These records will include diagnosis, treatment history and results of clinical tests (blood tests, x rays and scans, illness due to medications or your inflammatory disease, and any surgery
• If your treatment (or a suitable alternative) is not available in New Zealand you will need to seek information about importing it. You, or your health insurer, will be responsible for funding this. In this instance, check the medication has been approved by Medsafe. Visit Medsafe to learn more about importing medicines. If it is not approved, you may still be able to import the medication by following the procedure for personal use of medicines on the Medsafe Website
• The availability of biologics in New Zealand may not be the same as what you have been prescribed, however, there may be a suitable alternative. Your rheumatologist can support your application for the continuation of medications or alternatives. Pharmac, the medicines provider, lists all approved medicines in the community schedule