title: How the Trans Pacific Partnership Agreement could undermine PHARMAC and threaten access to affordable medicines and health equity in New Zealand.
abstract: New Zealand's Pharmaceutical Management Agency (PHARMAC) has been highly successful in facilitating affordable access to medicines through a combination of aggressive price negotiations, innovative procurement mechanisms, and careful evaluation of value for money. Recently the US government, through the establishment of a series of bilateral and plurilateral "free" trade agreements, has attempted to constrain the pharmaceutical access programs of other countries in order to promote the interests of the pharmaceutical industry. The Trans Pacific Partnership Agreement (TPPA) represents the latest example; through the TPPA the US is seeking to eliminate therapeutic reference pricing, introduce appeals processes for pharmaceutical companies to challenge formulary listing and pricing decisions, and introduce onerous disclosure and "transparency" provisions that facilitate industry involvement in decision-making around coverage and pricing of medicines (and medical devices). This paper argues that the US agenda, if successfully prosecuted, would be likely to increase costs and reduce access to affordable medicines for New Zealanders. This would in turn be likely to exacerbate known inequities in access to medicines and thus disproportionately affect disadvantaged population groups, including Māori and Pacific peoples.
authors.affiliation: School of Public Health and Human Biosciences, La Trobe University, VIC 3086, Australia. Electronic address: d.gleeson@latrobe.edu.au.
authors.forename: Deborah
authors.initials: D
authors.lastname: Gleeson
authors.forename: Ruth
authors.initials: R
authors.lastname: Lopert
authors.forename: Papaarangi
authors.initials: P
authors.lastname: Reid
mesh_terms: D003132:Commerce / Q000331:legislation & jurisprudence*; D003363:Cost Control; D003657:Decision Making; D016527:Drug Costs / Q000706:statistics & numerical data*; D004335:Drug and Narcotic Control / Q000331:legislation & jurisprudence*; D004465:Economic Competition; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006297:Health Services Accessibility / Q000191:economics / Q000331:legislation & jurisprudence; D006801:Humans; D007356:Insurance, Pharmaceutical Services / Q000191:economics*; D007391:International Cooperation; D017008:Negotiating; D009520:New Zealand; D004364:Pharmaceutical Preparations / Q000191:economics*; D014481:United States
chemical_list: D004364:Pharmaceutical Preparations
keywords: Access to medicines; Health equity; Pharmaceutical coverage programs; Trade agreements