15 January 2001
The Multiple Sclerosis Society of Auckland
The following is the unedited text of a letter from Pharmac general manager Wayne McNee to the MS Society
15 January 2001
Multiple Sclerosis Society
PO Box 2627
Various issues in respect of beta-interferon for multiple sclerosis (MS)
I am writing to you regarding two issues - in respect of funding for subsidised beta-interferon for MS patients and on the matter of certain letters that have been sent to PHARMAC by MS patients.
Funding arrangements for beta-interferon for multiple sclerosis (MS)
Firstly, I wish to formally advise you of the current situation regarding subsidised funding for beta-interferon.
When the Minister of Health made the decision to fund beta-interferon in December 1999 a cap was placed on the number of subsidised places that were to be made available. The cap, which was for 180 fully funded applicants, has now been met as of December 2000. Therefore, patients whose applications were/are first submitted to MSTAC after the cut-off date for December meeting and who meet the criteria cannot be commenced on funded beta-interferon therapy until a place becomes available.
Fortunately, we have been able to accommodate all those eligible patients whose applications were reviewed by MSTAC at the December meeting. There is also sufficient provision within the budget to approve all those patients whose applications have been assessed by MSTAC to date, where the decision whether or not to approve funding has been deferred.
Applications for subsidies for beta-interferon can still be submitted to MSTAC (the Multiple Sclerosis Treatment Assessment Committee) and those applicants that meet the entry criteria will be approved subject to funding being available for them to commence treatment.
A funded place could arise if:
1. a patient currently on subsidised treatment decides to withdraw from treatment;
2. a patient currently on subsidised treatment meets the criteria for stopping treatment and has the subsidy withdrawn (reassessments begin April 2001); or
3. PHARMAC allocates extra funding for treatment of patients above the 180 limit.
MSTAC meets approximately every month to review applications for subsidised treatment. Each month, before assessing any new applications, the committee will review the number of approved patients still receiving a subsidy for beta-interferon. If the number has fallen below the limit, patients who have been approved subject to funding will be allocated a subsidy. If there are more patients who have been waiting to commence treatment than there are places available, then patients who have been waiting longest will be granted a place first.
This advice was communicated verbally to your staff on Friday 12 January and there has already been media interest. We realize that the situation will cause disappointment and frustration for some MS patients and invite you to meet with us if you wish to discuss your concerns or any questions you have with us further.
As usual, if you wish to meet with us, please contact Christine Della Barca to arrange a time and place.
Correspondence from MS patients
On a separate matter, we are in receipt of a number of form letters from MS patients concerned about PHARMAC'S recent decision to widen access to pharmaceutical treatments for HIV/AIDS. We would very much like to have responded to these letters individually but, unfortunately, most of the authors did not supply their addresses. We are hoping that perhaps you know the origins of the letter (copies of which are attached), and might forward our response to the appropriate people.
The gist of the letter is that PHARMAC is unfairly discriminating against MS patients by funding treatments for patients with HIV/AIDS while only funding beta-interferon for a limited number of MS patients and under strict criteria. This opinion has been raised many times - in consultation, and more recently in statements that we understand have been made by MS Society representatives to the media.
We wish to point out that PHARMAC's decisions are based entirely on our decision criteria, which take into consideration the health needs of all patients in New Zealand. Indeed it is our role to balance scarce health resources across those needs. We regard all patients with health needs as equal regardless of the nature and/or origin of their diseases.
Your members seem to be suggesting that PHARMAC should not fund treatments for diseases caused by illicit, morally corrupt or irresponsible lifestyles. Would they also suggest that doctors should not treat patients injured whilst driving drunk? Are they suggesting that the New Zealand Government should not allocate resources to address the high rates of teenage pregnancies and chlamydia in New Zealand? These conditions all have known causes.
Your members are misinformed if they believe that HIV/AIDS sufferers have the level of access to treatments they consider to be ideal. While HIV/AIDS sufferers lobbied hard (and for even longer than MS patients) for access to treatments, they still do not have access to what they consider to be optimal treatment. Like MS patients, they have to meet strict clinical criteria before they qualify for subsidised treatment. Like MS patients, their disease is unpleasant and the treatments available are far from a cure. Unlike MS patients, they face the problem of the treatments that are effective and available to them becoming ineffective because of viral resistance. This is one of the reasons provision was recently made by PHARMAC to allow access to dual PI therapy. Other reasons include the fact that because of agreements that PHARMAC was able to achieve with suppliers the therapies were cost neutral, or close to it. Yes, there is a limit on the amount of funding PHARMAC will allocate to MS treatments and no such limit on HIV/AIDS treatments. However, that fact reflects the cost-effectiveness of HIV/AIDS treatments (and poor cost-effectiveness of beta-interferon) and scarce resources. Not, as you members suggest, discrimination against MS patients.
New research into beta-interferon will be taken into account when the criteria are reviewed. If it is concluded that there is evidence of benefit in patients with different characteristics than those in the current criteria, then it is possible that the criteria will be amended. However, the PHARMAC Board's approval of such amendments would still be contingent on justification under our Decision Criteria and the availability of any additional funding required. If the benefits of beta-interferon in such other patients are not greater than in those currently being treated, or the new evidence does not demonstrate improved cost-effectiveness in those patients or, even if it does, if beta-interferon is still not the best use of the available funds under our decision criteria, then it is possible that the criteria would not be widened immediately.
We realize that opinions on the allocation of health funding are strong and can often run high, but we also hope that with your assistance some of the erroneous statements that are currently being voiced by some MS patients can be answered appropriately. If you have any queries regarding this matter please do not hesitate to contact me.
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