PHARMAC widens access to funded treatments for multiple sclerosis

February 12, 2021 | Advocacy, Life with MS, Media, Treatments

Media Release – 12 February 2021 – Released by PHARMAC

PHARMAC announced today that it will be widening access to all funded multiple sclerosis treatments from 1 March. 1800 people with multiple sclerosis will be able to stay on their treatment for longer, and some who had stopped funded treatment may now be eligible to restart.

Multiple sclerosis is a progressive neurological condition that leads to increasing levels of disability. Jeremy Seed (Kai Tahu/ Kati Mamoe) has had multiple sclerosis for eleven years. The former New Zealand Army officer and father of two is relieved that he will be able to stay on his treatment for longer. “It is really good news. The 500 metre walk was an annual stressor, and I was worried each time I would no longer qualify for my medication. Ironically, stress can exacerbate MS, so not having to worry about it is fantastic,” says Jeremy.

To ensure ongoing eligibility for treatment, people with multiple sclerosis are assessed with the Expanded Disability Status Scale (EDSS).  This is a method of quantifying disability in multiple sclerosis and is used to measure and assess disease progression.

PHARMAC’s director of operations Lisa Williams explains, “We wanted to make sure that all those who were benefitting from the funded treatments were able to continue to get them. To support this, we are widening the eligibility criteria to people with an Expanded Disability Status Scale (EDSS) score of 0 (as soon as you are diagnosed and have had two qualifying relapses) to 6.0 (inclusive).”

An EDSS score of 6.0 means that someone can walk 100 metres with or without rest and/or assistance. They can use a cane, crutch or brace. Previously, they would have had to walk 500 metres without rest or assistance to stay on funded treatments.

“People with multiple sclerosis who stopped funded treatment due to the previous eligibility criteria may now be able to restart funded treatment. People should talk to their specialist to work out if that is an option for them.

“PHARMAC is also simplifying the application process for multiple sclerosis treatments,” says Lisa. “Rather than applying to a group of PHARMAC appointed clinical experts, clinicians will now use the standard electronic Special Authority process. This will make it quicker for people with multiple sclerosis to access funding for the medicine they need and less burdensome for clinicians to apply.”

Multiple Sclerosis New Zealand is pleased to see the changes to the Special Authority. “We have been advocating for these changes that will keep people on treatment for longer, thereby improving their brain-health, keeping them in work longer, active, and able to support their families and themselves. These changes will also help to speed up the approval process and relieve the pressure on New Zealand’s under-resourced neurology workforce,” says Multiple Sclerosis NZ National Manager Amanda Rose.

Having recently retired from the New Zealand Army, Jeremy now works for the Returning Services Association (RSA), supporting current and former military personnel and their families. “Being able to stay on my treatment means I can focus on the things that matter – my family first and foremost, and my new role with the RSA.”

For more information

Read the guidance for patients, prescribers and pharmacists

Read the full decision

Specific information for people with multiple sclerosis

• You will continue to receive your funded multiple sclerosis treatment in the same way as you do now. There will be no changes to the cost you currently pay for your treatment or the way you access your treatment.
• Most people with clinically definite, relapsing-remitting multiple sclerosis (CD RR-MS) will be able to receive their funded treatment for longer.
• The way your doctor or specialist applies for funding on your behalf is changing. Applications for funded multiple sclerosis treatments will be processed differently after 1 March 2021.
• People with multiple sclerosis who stopped treatment due to no longer meeting the previous eligibility criteria may now be eligible to restart funded treatment under the new criteria. People should talk to their specialist to determine if they meet the new renewal criteria.
• If you do not meet the renewal eligibility criteria due to a temporary non-multiple sclerosis related reason, your doctor or specialist will be able to apply for a Special Authority waiver for an extension of six months.
• PHARMAC anticipates all people with multiple sclerosis who are currently receiving funded treatment to be affected positively by this change.

(Note: This information has been taken from the PHARMAC website)

Brief Overview of Changes

From 1 March 2021:

• access to funded multiple sclerosis treatments will be widened to an Expanded Disability Status Scale (EDSS) score of 0 to 6.0 (inclusive)
• access to funded multiple sclerosis treatments will be managed via the standard Special Authority process
• the same Special Authority criteria will apply to all funded multiple sclerosis treatments.
• Approvals valid for 12 months where patient has had an EDSS score of 0 to 6.0 (inclusive) at any time in the last six months (i.e. the patient has walked 100 metres or more with or without aids in the last six months).

Note: There are currently eight funded multiple sclerosis treatments; natalizumab (branded Tysabri), fingolimod (branded Gilenya), interferon beta-1-beta (branded Betaferon), interferon beta-1-alpha (branded Avonex), glatiramer acetate (branded Copaxone), teriflunomide (branded Aubagio), dimethyl fumarate (branded Tecfidera), and ocrelizumab (branded Ocrevus).