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How to get the NZ Govt to fund your Sativex

So you’ve just been approved for Sativex,  great! welcome to an exclusive club.

Unfortunately unless you are in the top 5% of NZ incomes, the cost of Sativex is impossibly hard to stomach.  3 Bottles are frequently quoted as costing approx $1300, this is with the pharmacies taking a large markup, so be sure to grease up to your friendly pharmacist in the hope of a reduced markup, the lowest MCaNZ has heard is that it can cost $990 from a sympathetic pharmacy.

Currently, we are aware of 4 methods of obtaining funding for Sativex, 3 of which we aware have worked, they are;

  1. ACC funding
  2. WINZ Temporary Additional Support
  3. WINZ Special Benefit
  4. NPPA; (no success so far)

 

ACC Funding,

It is possible to have ACC fund Sativex, MCaNZ is currently aware of 2 people who have had ACC pay for their Sativex off label for chronic pain, one has Complex Regional Pain Syndrome, the other had several nerve roots damaged in a botched spine operation.  As an off label use for pain, ACC will decline it by default. The key to win over ACC for unapproved or off label use is to pay for it yourself for 3 months, and if it works very well, take ACC to review.  In review, moving stories from the claimant and families of the improvement in quality of life should overrule the defensive arguments that ACCs (likely expensive) Lawyer will try and dish up regarding lack of evidence etc. Personal use with improvements is all the evidence a court needs to outweigh theoretical arguments of no benefit and or lack of evidence, the patient is the evidence.

WINZ Temporary Additional Support

It is possible to have WINZ pay for Sativex for up to 12 weeks, at a funding level of 80% for the medicine, this has been done for a patient in Northland and although not complete funding, this option is  accessible to many, and should make Sativex affordable enough to confirm if it works or not.

WINZ Special Benefit

The WINZ Special Benefit was closed to new beneficiaries in 2006, however, those who were still on the benefit would continue to remain so until they no longer qualify for this benefit. This has meant that the amount of people on the special benefit has gradually declined.  However recently we have become aware of someone on the special benefit getting Sativex paid for ENTIRELY out of the special benefit, as it was a prescribed medicine with the endorsement of a specialist, it his hard for WINZ to refute that.  This avenue is likely still open to several thousand people, and we have an OIA request in to find out how many people have this option available to them.

Named patient pharmaceutical assessment.

This is a method where under special circumstances a patient may have Pharmac pay for an unfunded medicine.  To date no one has been successful in applying, but it is an avenue to exhaust, as more requests will demonstrate demand.   Its interesting in that declining they will always cite a lack of evidence of efficacy, where if the patient is already having a successful trial of Sativex with improvement in symptoms this is not taken into account by the Pharmac NPPA review board.  This is clear prejudice against Medical Cannabis products that is an area where future advocacy and education can improve the outcomes. In another case, Intrathecal Baclofen was suggested by the NPPA review board, latest clinical best practice recommends the use of Sativex for Spasticity before considering such invasive procedures as an Intrathecal pump, further showing Pharmac to be out of touch with reality.

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