4.1 PHARMAC
With pharmaceutical expenditure rising at up to 15 % per
annum during the 1980s, faster than other health spending
[27], it was recognised that New Zealand needed a new
approach to pharmaceutical spending management. In
1993, the four RHAs became responsible for the pharmaceuticals
budget. Faced with an overall budget cap in
which they were expected to work, the RHAs jointly
established a Pharmaceutical Management Agency
(PHARMAC) to better manage pharmaceutical expenditure.
PHARMAC has gone on to become the most enduring
of the organisations established during the 1990s reforms
[28] and highly successful at restraining medicines
expenditure in New Zealand, expanding the range and
volume of medicines able to be accessed by New Zealanders
at far lower levels of expenditure than would
otherwise occur [29]. Key features of its work include [30]: