Christian Heritage Party Again Questions Pharmac Drug Swapping Decision Making

Gael Donoghue, Health spokesperson for the Christian Heritage Party say, “The Party shares the disquiet re Pharmac’s policies of swapping ‘brand name’ drugs for generics with cardiologists who gathered recently in Wellington from Australia and New Zealand for their Annual Cardia Scientific Meeting. (Article NZ Doctor (August 18.) The complexities of switching patients off their existing medication was a major focus of the meeting, and their concern was expressed in regard to a further ACE inhibitor switch possibility proposed by Pharmac if major savings can be made.

“I have expressed my concerns in these matters before, that the policies seem to be driven by monetary decision, rather than what is best for the patient,” says Mrs Donoghue, herself a pharmacist. My concerns are shared by many of my colleagues too, who have no choice in regard to dispensing ‘preferred supplier’ medicines, which Pharmac dictates. There is evidence from colleagues and GPs who have seen, for example, instability in patient’s blood pressure as patients are switched to generic (cheaper) drugs, and side-effects that cause unnecessary problems for the patient, who may have to return several times to the GP until medication stability is restored. This hits the patient’s pocket again as well, with more doctor visits and prescription charges,” Mrs Donoghue says.

“Whilst fiscal imperative is there, and understood by pharmacists and medical colleagues the patient’s health and safety should never be compromised by cost factors alone,” she said. “I am gratified to learn that participants at the Conference suggested Pharmac should seek ethical approval before embarking on brand switches,” she said. “Clinicians say it would be totally unacceptable for them to run trials asking patients to switch medication without seeking ethical approval. The Christian Heritage Party is also very interested in the Wellington Ethics Committee chair saying that ethics committees are itching to have a look at some Pharmac decisions. We also question the fact the Pharmac does not have to answer to the Commerce Commission, as all other businesses in New Zealand do, in regard to its monopolistic, unilateral decision making,” she said.

“Further, says Mrs Donoghue, the latest NZMA newsletter informs that Pharmac is considering developing strategies to encourage doctors to actively prescribe generics rather than ‘brand’ drugs, viewing prescribing generics as Best Practice! – even promoting the idea of Continuing Education points for generic prescribing and the modification of software to default to generic names. This borders on coercion in my opinion,” she said. “I wonder how far the medical profession will be dictated to,” asks Mrs Donoghue.

“I agree with Dr Elliott, Christchurch School of Medicine Senior Lecturer in Cardiology who says a proven agent should definitely not cost more than an agent without evidence – ‘the cost of getting it wrong is huge’ he said. The medico-legal implications and risks of all these policies lie at the door of the doctors who prescribe, and the pharmacists who dispense,” says Mrs Donoghue, “particularly with the Health and Disability services consumer code in force.”

The worry for these health professionals is that the policy makers – Pharmac and the HFA will not have a case brought against them, but that patients with side-effects or complications from these changes will charge the doctors and may be the pharmacists. Solicitor David Collins, the medico-legal expert who acted for Rau Williams in the last days of his life, is concerned about doctors decisions being made clear as to whether they are made on a clinical basis or when in fact rationing of health resources is the key factor.

The Christian Heritage Party calls on the Minister of Health to arrange an independent review of Pharmac’s rationing and drug substitution policies, including clear documented evidence used from all drug companies in regard to bio availability and bio equivalency of their products. “We also believe the review should include Medical Ethics Committee members. This will allay the real concerns of all health professionals involved, and the public taxpayer patients who are finding these constant changes to their medication confusing, irritating and to the elderly bewildering,” concluded Mrs Donoghue.

ENDS

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