Ramy Burjony's Blog

Every so often when the fax machine goes off and the letterhead reads Pharmac, I wish for some commonsense to prevail. But guess what? It never does. 

I understand Pharmac representatives have a very difficult job and they base their decisions on numbers, statistics, and studies etc. However sometimes commonsense needs to take the front seat.

Every once in a while changes in the Pharmaceutical Schedule are implemented that either see new pharmaceuticals scheduled, part payments removed and added or existing products de-listed.

I have many issues with the Pharmaceutical Schedule, but will only mention the few that have been bugging me. 

•         Flixonase being fully funded while there are part charges for Alanase and Butacort, even though the latter two nasal steroid products are cheaper.
•         Premarin - hormone replacement therapy with a huge part charge and no generic alternative fully funded.
•         Small part charge on quinine tablets makes you look foolish when asking the customer for 40c on a quinine repeat. 

There are plenty of products funded and usually more than one to treat the same condition. I always wonder why Otrivin nasal decongestant is not funded. It’s a great product and there is nothing on the schedule for nasal congestion, despite there being more than on eye decongestant. It would be an ideal product to fund, especially with pseudoephedrine close to becoming a controlled drug.    

Fluconazole 150mg capsules for vaginal thrush are not funded unless under a specialist or specialist prescription. How does this make any sense? A woman sees her doctor, gets a prescription, yet it is still not funded. Where is the motivation to see your doctor? Not only did she just pay for a consult, she also pays in full for the treatment. Why not put a restriction on one funded capsule per prescription like they do with many other pharmaceuticals. 

Blood glucose testing strips - one box per prescription funded unless you are on a sulphonlyurea or insulin. Ok so let us get this straight, if you are a newly diagnosed diabetic, you are not allowed to test frequently because we can only give you 50 strips at one time. How does this teach patients that diabetes is a chronic disease requiring strict monitoring? I understand research shows testing among non insulin and sulphonlyurea users has not been proven to be effective, but at least place some restriction on the funding (such as prescriber’s choice or open funding if diagnosed within the first six months). It is difficult trying to explain to a newly diagnosed diabetic they will have to pay for their repeats because they can only get one funded box. And of course what happens when you are newly diagnosed? You are new to the experience, you are anxious and you tend to test a lot and waste a large number of strips. 

But no instead let’s fund three or four different makes of diabetes meters. Let’s fully fund the more expensive form of nasal steroid sprays. Let’s fully fund a variety of flavoured condoms.

When it comes to major decisions on whether to fund treatments that cost the government thousands, I am pleased Pharmac is there to make them.

My problem is with small funding issues, such as the ones mentioned above, that make a huge difference to the patient and little to the funder. Once again, let’s get some real perspective and commonsense within the Pharmac decision makers.  

Ramy Burjony

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