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New Zealand drugs row set to continue
POLICY AND PEOPLE
ast year was a particularly turbulent time for the New Zealand pharmaceutical market, with the government’s drugs purchaser (PHARMAC) battling against the Researched Medicines Industry (RMI)—a lobby representing 33 transnational corporations that sell brand-name drugs. In part because of its remoteness, small population, and lack of domestic drug manufacture, New Zealand has traditionally paid top prices for branded medicines. The country also faces a rapidly growing drugs budget because of rising prescription volumes and patented pharmaceutical advances in cardiovascular medicine, gastroenterology, and psychiatry. PHARMAC’s tool to stem rising expenditure is reference pricing. This scheme groups medicines together based on “same or similar therapeutic effects” for the “same or similar conditions” and then subsidises drug purchase only up to the cost of the cheapest in the group. Manufacturers of the more expensive drugs must then drop their prices or face loss of market share, since patients will have to pay part-charges. Reference pricing has been implemented or is being considered in several European countries as well as Canada and Australia. Predictably, RMI and allied lobbies in other countries have been a vociferous opponent of reference pricing. In November, RMI mounted an emotive US$1-million “Mayday” advertising blitz, warning prescribers and the general public of “loss of choice” and exhorting action before it is “too late”. The campaign seemed to backfire when it attracted unexpected criticism from consumer groups, the Minister of Health—who argued the government’s case before the Advertising Standards Complaints Board—and the New Zealand Medical Association, which had supported many of RMI’s more temperate arguments. After 3 cacophonous weeks, the “Mayday” campaign was dropped, with RMI claiming to have “attracted public attention”. The battle seems set to continue. Several lawsuits are being brought against PHARMAC by pharmaceutical houses, while research commissioned by RMI has shown that up to 7% of New Zealanders may find their regular prescriptions affected by reference pricing in 1998.
L
David Menkes
THE LANCET • Vol 351 • January 17, 1998
Survey prompts changes to refugee treatment The survey was made public on Dublin doctor’s survey of Jan 4. Torture and abuse victims refugees has helped towards the were mostly from Nigeria, Zaire, setting up of a new programme in Libya, and Algeria, with others comIreland for the treatment of torture ing from eastern Europe. The survey victims. Philip O’Connell’s survey of also found that most refugees experirefugees and asylum seekers showed enced loneliness and depression, that 44% of those surveyed were vicunderlined by tims of torture or “terrible sadness major psychologand emotional ical abuse in their trauma”. home countries. The findings O’Connell, were presented who works at the to the Eastern Refugee Medical Health Board Centre run by in December—on the Eastern Jan 8, the Board Health Board at announced provia Dublin teachsion of “substaning hospital, Refugees face problems across Europe tial funds” for the decided to survey assessment and treatment of victims the patients he saw during a 3-week of torture. The Board will also be period in November, 1997. His aim undertaking a multilingual publicwas to get some “hard data” to counawareness programme for refugees to teract repeated assertions by local explain the medical services available politicians that refugees were simply and to dispel fears that they would looking for a better economic life. face deportation if found to have an “There is a belief out there that infectious disease. almost all refugees are here for purely The government now intends to economic reasons. It’s not true. My put all refugee services under a findings show that many have single roof in a purpose-built facility physical marks of torture such as planned for central Dublin. This electric burns, slash wounds, partial one-stop centre will house officials amputations, and whip scars”, said from the Departments of Justice and O’Connell. Some had written docuSocial Welfare, along with a new, mentation of their ordeals. Others expanded medical centre. recounted horrific rapes and psychological abuse such as being forced to watch as soldiers killed their child. Karen Birchard
A
Associated Press
New Zealand drugs row set to continue
Clinton proposes US Medicare expansion
H
aving expanded children’s health-insurance coverage in 1997, President Clinton has turned in 1998 to another group with low rates of insurance coverage—the “near elderly”. On Jan 6, the President announced his proposal to allow some people older than 55 years to “buy into” the Medicare programme, for which eligibility normally starts at 65 years. Under the plan, people aged 62–64 will be able to pay a fixed premium to purchase Medicare coverage. Those aged 55–62 years will be able to purchase Medicare coverage if they are laid off from their jobs or their employer drops health-insurance coverage. Another part of the proposal will allow early retirees to continue to buy insurance through their former jobs until they are old enough to receive Medicare coverage. Currently, such extended
coverage lasts only 18 months. Republicans were less than enthusiastic about the proposal. Many have complained that Clinton is trying to do piece by piece what he failed to accomplish in 1994—to guarantee universal coverage—a charge that has not been denied. Republicans also claimed that Medicare’s long-term solvency is still questionable. Another proposal Clinton will reportedly make in the budget he submits to Congress in early February—a substantial increase in funding for biomedical research—is likely to gain more support from Republicans. Leading Republicans have for the past year made doubling the budget for the National Institutes of Health within the next 5 years one of their top priorities. Julie Rovner
195
ast year was a particularly turbulent time for the New Zealand pharmaceutical market, with the government’s drugs purchaser (PHARMAC) battling against the Researched Medicines Industry (RMI)—a lobby representing 33 transnational corporations that sell brand-name drugs. In part because of its remoteness, small population, and lack of domestic drug manufacture, New Zealand has traditionally paid top prices for branded medicines. The country also faces a rapidly growing drugs budget because of rising prescription volumes and patented pharmaceutical advances in cardiovascular medicine, gastroenterology, and psychiatry. PHARMAC’s tool to stem rising expenditure is reference pricing. This scheme groups medicines together based on “same or similar therapeutic effects” for the “same or similar conditions” and then subsidises drug purchase only up to the cost of the cheapest in the group. Manufacturers of the more expensive drugs must then drop their prices or face loss of market share, since patients will have to pay part-charges. Reference pricing has been implemented or is being considered in several European countries as well as Canada and Australia. Predictably, RMI and allied lobbies in other countries have been a vociferous opponent of reference pricing. In November, RMI mounted an emotive US$1-million “Mayday” advertising blitz, warning prescribers and the general public of “loss of choice” and exhorting action before it is “too late”. The campaign seemed to backfire when it attracted unexpected criticism from consumer groups, the Minister of Health—who argued the government’s case before the Advertising Standards Complaints Board—and the New Zealand Medical Association, which had supported many of RMI’s more temperate arguments. After 3 cacophonous weeks, the “Mayday” campaign was dropped, with RMI claiming to have “attracted public attention”. The battle seems set to continue. Several lawsuits are being brought against PHARMAC by pharmaceutical houses, while research commissioned by RMI has shown that up to 7% of New Zealanders may find their regular prescriptions affected by reference pricing in 1998.
L
David Menkes
THE LANCET • Vol 351 • January 17, 1998
Survey prompts changes to refugee treatment The survey was made public on Dublin doctor’s survey of Jan 4. Torture and abuse victims refugees has helped towards the were mostly from Nigeria, Zaire, setting up of a new programme in Libya, and Algeria, with others comIreland for the treatment of torture ing from eastern Europe. The survey victims. Philip O’Connell’s survey of also found that most refugees experirefugees and asylum seekers showed enced loneliness and depression, that 44% of those surveyed were vicunderlined by tims of torture or “terrible sadness major psychologand emotional ical abuse in their trauma”. home countries. The findings O’Connell, were presented who works at the to the Eastern Refugee Medical Health Board Centre run by in December—on the Eastern Jan 8, the Board Health Board at announced provia Dublin teachsion of “substaning hospital, Refugees face problems across Europe tial funds” for the decided to survey assessment and treatment of victims the patients he saw during a 3-week of torture. The Board will also be period in November, 1997. His aim undertaking a multilingual publicwas to get some “hard data” to counawareness programme for refugees to teract repeated assertions by local explain the medical services available politicians that refugees were simply and to dispel fears that they would looking for a better economic life. face deportation if found to have an “There is a belief out there that infectious disease. almost all refugees are here for purely The government now intends to economic reasons. It’s not true. My put all refugee services under a findings show that many have single roof in a purpose-built facility physical marks of torture such as planned for central Dublin. This electric burns, slash wounds, partial one-stop centre will house officials amputations, and whip scars”, said from the Departments of Justice and O’Connell. Some had written docuSocial Welfare, along with a new, mentation of their ordeals. Others expanded medical centre. recounted horrific rapes and psychological abuse such as being forced to watch as soldiers killed their child. Karen Birchard
A
Associated Press
New Zealand drugs row set to continue
Clinton proposes US Medicare expansion
H
aving expanded children’s health-insurance coverage in 1997, President Clinton has turned in 1998 to another group with low rates of insurance coverage—the “near elderly”. On Jan 6, the President announced his proposal to allow some people older than 55 years to “buy into” the Medicare programme, for which eligibility normally starts at 65 years. Under the plan, people aged 62–64 will be able to pay a fixed premium to purchase Medicare coverage. Those aged 55–62 years will be able to purchase Medicare coverage if they are laid off from their jobs or their employer drops health-insurance coverage. Another part of the proposal will allow early retirees to continue to buy insurance through their former jobs until they are old enough to receive Medicare coverage. Currently, such extended
coverage lasts only 18 months. Republicans were less than enthusiastic about the proposal. Many have complained that Clinton is trying to do piece by piece what he failed to accomplish in 1994—to guarantee universal coverage—a charge that has not been denied. Republicans also claimed that Medicare’s long-term solvency is still questionable. Another proposal Clinton will reportedly make in the budget he submits to Congress in early February—a substantial increase in funding for biomedical research—is likely to gain more support from Republicans. Leading Republicans have for the past year made doubling the budget for the National Institutes of Health within the next 5 years one of their top priorities. Julie Rovner
195