The acting prime minister has laid out his expectations for the drug buying agency. As Stewart Sowman-Lund writes in today’s extract from The Bulletin, it’s of little surprise. To receive The Bulletin in full each weekday, sign up here.
A letter of expectation
Politicians like to routinely criticise Pharmac but are often apprehensive about getting too involved with it. The drug buying agency sits at arm’s length from government, as illustrated most recently with the saga over cancer drugs. In opposition, National had promised 13 named drugs would be funded. But after being elected, it realised that was opening a can of worms and instead opted to boost Pharmac and let it decide which medications it would make available. Yesterday, the acting prime minister (and the minister who just happens to be responsible for Pharmac) David Seymour came as close as an MP can to interfering with Pharmac’s own business. Ministers may have no control over what drugs Pharmac buys, but they can issue letters of expectation to guide the agency on how to act in a range of areas.
What was directed?
The Herald’s Adam Pearce has the key details here, reporting that Pharmac has been instructed to stop consideration of the Treaty of Waitangi and make efforts to improve public trust in the organisation. We’ll get to the Treaty issue, which is unsurprisingly attracting the most media attention, below. But that’s not all the letter has outlined. Seymour also encouraged Pharmac to involve patient groups more in decision making, a move welcomed by Patient Voice Aotearoa. “Patient advocates welcome working alongside the government and Pharmac to usher in a new era where our drug procurement agency can be vastly improved for the benefit of patients. The letter of expectations signals that era is beginning,” the group’s chair Malcolm Mulholland said.
As noted by The Post’s Rachel Thomas, Seymour said that Pharmac should have “appropriate processes” for ensuring that people living with an illness, along with their carers and family, can participate in and provide input into decision-making processes around medicines.
Act’s views on Pharmac
Pharmac had never featured so prominently in an election campaign as it did in 2023, reported The Conversation. “Many parties are pledging more funding, but two are promising to overhaul the agency as we know it,” read the piece from October 2023. Those two parties? New Zealand First and Act. The former had promised a new medicines buying agency entirely. That’s unlikely to come to fruition but something similar was reportedly considered as the coalition decided how to fund those additional cancer medications.
Act’s proposal was dubbed the most “radical”, promising to overhaul regulatory approval processes and decision making. Being in coalition means Act’s hopes for Pharmac may be tempered somewhat, but Malcolm Mulholland, in his statement endorsing the letter of expectation, said it was clear that Seymour’s objective was “clearly to reform Pharmac”.
The controversy over the treaty
The inclusion of the Treaty in Pharmac decision making only dates back a couple of years following a review of the agency ordered by the last government. That review, as RNZ’s Giles Dexter reported at the time, deemed that Pharmac was under-serving Māori, Pacific people and people with rare disorders. The agency was subsequently instructed to consider how it could help embed Te Tiriti o Waitangi across the health sector. Seymour, yesterday, said he believed that was inappropriate. “[Pharmac] should serve all New Zealanders based on actual need, without assigning their background as a proxy of need,” he said in his letter of expectation. It could prove controversial among some health professionals. Oncology professor Chris Jackson, on Twitter, said he agreed with Seymour that Pharmac’s focus on Te Tiriti had been performative – “just in the opposite direction to what he thinks”. And in an interview earlier today with RNZ’s Morning Report, former Māori Health Authority clinical lead Dr Rawiri McKree Jansen called the removal of the Treaty consideration “disappointing” and “playing to [Seymour’s] base.”
Seymour’s views are of little surprise given he’s also the architect of the government’s Treaty Principles Bill which would redefine the principles of Te Tiriti and unify it across legislation. According to Newsroom Pro’s Laura Walters (paywalled), we’re very close to seeing the draft of that proposed law – it will be released next week. National has promised to kill that bill after its first reading. Nevertheless, Seymour, by having his eyes across other portfolios, has managed to move on what he wants, or at least expects.