Pharmac extends cancer medicine funding to about 15 more people a year

From 14 October, eligible adolescents and young adults with paediatric-origin cancers can get funded cancer medicines under an update to Rule 8.1(b) of the Pharmaceutical Schedule.

Rule 8.1(b) gives children with cancer, treated in a paediatric oncology service, funded access to any medicine used to treat their cancer. Around 15 adolescents and young adults each year are expected to become eligible for funded treatment.

A paediatric-origin cancer is one of a defined group of cancers that typically arise in childhood. They are commonly treated using paediatric-based treatment protocols.

Some adolescents and young adults with these cancers receive the same or very similar treatment as children. However, access to medicines depends on where they receive care.

“Cancer in childhood and adolescence can have lasting impacts on health, but also on education, employment, and social development,” said Dr David Hughes, Pharmac’s Chief Medical Officer.

Under the change, eligible adolescents and young adults can access funded medicines whether they receive care in a paediatric or adult setting.

Who is eligible

Pharmac’s policy sets three criteria, and all three must be met. First, the patient has a cancer on Pharmac’s defined list of paediatric-origin cancers.

Second, the patient is being treated using a paediatric-based treatment protocol, whether in a paediatric or adult haematology/oncology service. Third, the patient is eligible for AYA cancer services under the Health New Zealand Tier 3 Service Specification.

Eligibility should be determined through established clinical governance processes, including multidisciplinary team or multidisciplinary meeting (MDT/MDM) review, where appropriate.

Children treated within New Zealand’s two recognised paediatric oncology and haematology services remain eligible under existing arrangements.

How the decision was made

The decision follows earlier reviews of rule 8.1(b) and consultations with clinicians and the families of children and adolescent cancer patients.

Pharmac worked closely with other health agencies, the Adolescent and Young Adult Cancer Network Aotearoa, the National Child Cancer Network, and Pharmac’s Cancer Treatment Advisory Committee. It did so to make sure the change is fair and workable.

What clinicians need to do

The treating clinician, pharmacist or authorised delegate must notify Pharmac when medicines are used under the policy. They do this by completing and submitting the approved Paediatric Oncology Medicine Notification Form.

Submitting the form is not a request for approval and does not affect eligibility. Pharmac may use the information for monitoring, forecasting, implementation and policy review.

The policy will be reviewed every three years, or more often if required.