Pharmac and Te Tiriti: Changes labelled 'performative', some question relevance

A patient advocate says David Seymour's new instructions to Pharmac could do more for Māori access to medicines than simply having a "Te Tiriti provision".

The associate health minister has directed Pharmac to stop factoring Te Tiriti o Waitangi into its decisions, instead urging the agency to focus on delivering health outcomes based on data and evidence.

Seymour said Pharmac should serve people based on actual need, without considering their background as a proxy.

"Every moment you're thinking about that, you're not thinking about how do we get to better outcomes. I think it's going to help all people's health statistics in the same way… We've got to be open about the fact that sometimes ethnicity's a factor, sometimes it just isn't."

While the move has the backing of Pharmac board chair Paula Bennett and Patient Voice Aotearoa chair Malcolm Mulholland, it has not impressed former Māori Health Authority clinical lead Dr Rawiri McKree Jansen.

"It's pretty disappointing. I think it's quite performative," Jansen told Morning Report on Wednesday.

"I think he's just playing to his base because actually, when you get into it, the evidence is really clear that Māori are missing out on a whole lot of health services and specifically in the medicine space Māori are missing out, so I think there's so much more that Pharmac can do."

Jansen said Māori, through inequitable access to healthcare, were missing out on a million prescriptions a year.

"That's an impact on Māori health outcomes. I think Pharmac needs to do a much better job of getting optimal use of medicines that they fund… You don't want people doing a whole lot of using drugs that is unnecessary. You don't want to fund drugs and then not have the system use them. You actually want the system to be well-informed and well-supported to do the best job possible with those medicines. That is Pharmac's mahi, it really is."

Bennett told Morning Report she was not aware how, at an operating level, Pharmac's prior directive around Te Tiriti was implemented, having "only been in the role for a couple of months".

But she insisted its removal would not make Māori worse off.

"I think it's just going to make sure that we're, you know, clearly focused on delivering, you know, more medicines for all New Zealanders, including Māori. So it certainly doesn't stop us from wanting to see better access and better medicine.

"But I think as an organisation, we had a clear mandate from the previous government. The organisation has spent a lot of resource and a lot of time on that. And now the focus is on a clearer definition I think of delivering for everybody."

Another aspect of Seymour's letter to Pharmac was to consider the wider fiscal impact of funding or not funding a medicine - whether for example, spending more on a particular drug would reduce the need for costly interventions later on, such as surgery, if it was not funded.

"From what I understand, there was sort of five or six lung operations a year, and now there's been one since that's happened in the last 12 months with that particular medicine," Bennett said of the decision to fund Trikafta. "So, you know, we can see the evidence of that with fewer hospital stays."

Mulholland said it was "very difficult to see how the Te Tiriti provisions were being applied in the first place" and said there was no evidence the provision helped Māori get access to medicines.

"What I would say is that by expanding the health technology assessment process again to look at all of those costs in a very holistic way, is actually a very Māori way of approaching a problem. And it could be that Māori actually benefit greater from that change if you like, as opposed to a Te Tiriti provision."

He said Pharmac's previous approach of "cost containment" was "myopic".

" I think what will be interesting to see is if that statutory objective is changed and if Pharmac are tasked with taking into consideration all the costs - whether that be within the health system or wider across government - then I think Pharmac could be strengthened, if you like, to make a stronger case for funding.

"And that funding would flow back to Pharmac, and then patients would receive the medicines that they want, including some of those new, innovative products."

Seymour on Tuesday also referenced the 2022 review into Pharmac which called for more transparency and timeliness from the agency. (The same report led to the then Labour government introducing Te Tiriti principles into Pharmac's operational framework in order to address inequities.)

Seymour said Pharmac would be required to publish how it was progressing on improving transparency and timeliness.

"We're going to really endeavour to, you know, how we simplify something that's often very complicated and very technical and how we actually get that messaging out there as well," Bennett said.

"But I want to do it with [patient advocates]. I don't want to sort of sit here and define transparency myself, because what I might term is that might be quite different than what Patient Voices and what the advocates do.

"So I think working with them in a respectful, open way, and I think everyone now wants to get around the table together and really look genuinely at all stages of it, understand why actually, the journey is sometimes for a medicine to be funded, you know, because we are also having to negotiate, and so in that there's a respect and confidentiality as well.

"So you know, we're going to have to work our way through that. But let's do that openly and transparently."

Seymour did not respond to Morning Report's invitation to come on the programme.