12. Dr JONATHAN COLEMAN (National—Northcote) Link to this
to the Minister of Health
Why has Pharmac replaced Ritalin SR with Rubifen SR as the subsidised medication for the treatment of attention deficit hyperactivity disorder?
Hon PETE HODGSON (Minister of Health) Link to this
Pharmac did so because it can save $1 million per annum, for the same drug, and use the money elsewhere to buy other drugs.
Dr Jonathan Coleman Link to this
Is the Minister aware of reports that children whose medication has been changed from Ritalin to Rubifen have displayed a marked deterioration in behaviour, which in some cases has resulted in children having to be removed from school; if so, what action will be taken?
Yes, I am aware. The reactions to this drug, or to any other drugs, are collected always by the centre for adverse reactions monitoring, which is based in Dunedin. It advises that of the more than 6,000 children currently on this drug, fewer than 20 have reported any effects. Of those 20, there is no pattern to the effects, and the centre for adverse reactions monitoring therefore, at this point, has no advice to offer Pharmac.
Dr Jonathan Coleman Link to this
Does the Minister acknowledge that this is a problem for families like the Celliers family of North Shore, whose little 8-year-old’s behaviour deteriorated so badly when he was changed from Ritalin to Rubifen that he had to be removed from school and was unable to go back until his parents started paying for the Ritalin themselves?
Yes. I do not myself name individual New Zealanders who have issues, but I am aware of the case. I just say to the member that this is the same drug. It has the same active ingredient, and when we look at the bioavailability graphs, which by the way have been sent out to every prescriber, we see the graphs are super-imposable. That does not mean there is not some idiosyncratic response from some young children, from time to time. My understanding is that this family has reapplied for an “exceptional circumstance”.
Dr Jonathan Coleman Link to this
Can the Minister see there is a fundamental disconnect between Vote Education and Vote Health when a little 8-year-old has to be taken out of school like that, with all the disruption and cost that that entails; and what would the Minister say in the case of children who are removed from school, who need Ritalin in order to go back, but whose parents cannot afford up to $145 per month to pay for it?
The member is a doctor and he has not heard me! So let me say this again. We are dealing with exactly the same active ingredient, and when we look at the pharmacokinetics we find exactly the same bioavailability. In other words, the drug levels are the same. Therefore the drugs are the same. What happens is that the coating of the drug may have caused some effect in some child. This is happening to a very modest degree. It would happen if the change in drug had occurred the other way. What is most likely, so advises one paediatrician, is that there is a reaction between the little boy’s long-term Ritalin and his short-term Ritalin.
Hon Dr Michael Cullen Link to this
Is there an interesting disconnect between people arguing for improvement of productivity in the health care system and always opposing any kind of cost reductions that occur within it?
The member makes a good point. This drug had $1 million shaved off the cost, by virtue of a tendering process. The tendering process is an effort to get competition into the drug industry. It is an effort to get value for money in the health system. Since 1998, tendering has saved $300 million. The Government does not lack ambition when it comes to getting value for health in the health system. What is more, we monitor all drug reactions to ensure that if there are any responses, there is no pattern to them. If there is a pattern to a response, then there is reconsideration—on the spot.