New Zealand Pharmacy Services

1. New Zealand Pharmacy Services Andi Shirtcliffe B. Pharm, PG Dip (Clin) Pharm, Reg Pharm NZ Chief Advisor – Pharmacy, New Zealand Ministry of Health

2. What we will cover • - The history and basic structure of the new community pharmacy services contract. • Community Pharmacy Long Term Conditions adherence support service (LTC) • Brief discussion about other services under the contract • PHAMS • CPAMS • Immunisation

3. Community Services Pharmacy Agreement (CPSA) • Community pharmacists are funded by District Health Boards (DHBs) via the CPSA. • The new agreement is being implemented in phases, with full roll out in 2015. • The Community Pharmacy Services Governance Group (CPSGG) is providing oversight and the Operational Group (CPSOG) is managing implementation of the CPSA.

4. Reasons for change in funding model • DHBs had been experiencing dispensing cost growth of 8-9% per annum over the last decade which was unsustainable. • The new CPSA has shifted from a fee-for-dispensing, volume based agreement, to a largely patient-centred model and payment system. • Total dispensing volumes have reduced since the commencement of the new CPSA.

5. Funding Envelope • The CPSA funding envelope was $370.5 million in 2012/2013, which was $10 million more than in 2011/12 (prior to the new agreement). This extra funding was injected into the sector to provide financial stability through this period of considerable change. • The annual funding envelope will increase by a contribution to cost pressure.

6. The new service model places an emphasis on the management of long-term patients’ medicines rather than on dispensing only. These changes include: • Pharmacies becoming focused on services to patients who need extra help with taking/managing their medications, with funding linked to services for patients with complex needs. • Pharmacies working more closely with doctors to identify patients who need extra help with taking/managing their medications.

7. Services under the new contract • Community Pharmacy LTC (Long Term Conditions) Adherence Support Service • PHAMS (Pharmacy High Needs Adherence Management Service) • CPAMS (Community Pharmacy Anticoagulation Monitoring Service) • Some of the services from the old contract were carried over e.g. • Clozapine dispensing • Methadone dispensing

9. Introduction to the LTC Service • The LTC Service is designed to provide the services required by those patients who not only have significant long term conditions but also require a high level of pharmacy support to remain adherent to their medicines regimen. • There is no extra cost to the patient. • There are two sides to the LTC Service eligibility – the long term conditions themselves and significant adherence issues. To qualify, a patient must score a minimum of 10 points in both LTCs and adherence issues.

12. Long Term Conditions Service (LTC) - continued • Patients are contractually required to have monthly contact with pharmacists • The nature of this contact and other relevant information will be documented in a medicines management plan. • Medicines management plans will be communicated to prescriber where clinically relevant. • Eligibility and management plan are reviewed at least annually.

14. Initial Patient Screen

15. Eligibility Assessment Process

16. Eligibility Assessment Process

17. Eligibility Assessment Process

22. Medicines Management Plan

23. Medicines Management Plan

24. Patients Review and Exit from LTC Service

27. Pharmacy High Needs Adherence Management Service (PHAMS) • An intensive medicines adherence support dispensing service. • Needs the input of a secondary care clinician to approve eligibility. • Need to be registered as a LTC patient first • Patients fulfil certain criteria e.g. high risk admission, risk to self or others. • Must be unable to manage their medicines and not already receiving help with managing their medicines from other sources.

28. Community Pharmacy Anti-Coagulation Management Service (CPAMS) • The Community Pharmacy Anti-Coagulation Management Service (CPAMS) Services is being implemented widely through the CPSA, with over 70 community pharmacies contracted and 1478 patients receiving this service. • Patients are tested in a pharmacy with a finger prick sample of blood and their warfarin dosage adjusted immediately if required, rather than having to go to the laboratory and be phoned later with results. • General Practitioners are informed of all test results, and provide input on dose adjustment decisions for results that fall outside a predetermined range. That is, General Practitioners retain control over the patient’s dosage.

29. Community Pharmacy Anti-Coagulation Management Service (CPAMS) - continued • In some areas GPs are slower to partner with pharmacies. In areas where good relationships have been built experience is showing that some GPs want to refer all patients across, not just the well controlled patients as currently required by the service guidelines. • Feedback has identified that patients are highly satisfied with the convenience of the service and more motivated to comply when they see their results on the computer screen immediately.

31. Immunisation • The Ministry of Health’s Medicines Reclassification Committee has reclassified a range of vaccinations to be available for supply by suitably trained Pharmacists: Prescription only medicine except when administered to a person 18 years of age or over by a registered pharmacist who has successfully completed a vaccinator training course approved by the Ministry of Health and who is complying with the immunisation standards of the Ministry of Health

32. Thank you