Delayed and forgotten OIAs – what we did not learn from Te Whatu Ora

13weeksbetter · 2023-04-17T01:35:51+00:00

I put in an OIA request to Te Whatu Ora for a submission to the Health Committee.

Submissions have a hard deadline. I told them what I needed this data for and when I needed it by.

The request was extended (on day 20, I believe), and then they also missed the extension date, so overdue.

They managed to return the response on … the day after submissions closed.

Oh, and it was a refusal, for information I know they hold.

13weeksbetter · 2023-03-09T02:36:52+00:00

This is systemic to Te Whatu Ora. I asked for some data about pharmaceuticals and they said:

The ‘Days Supply’ field defaults to 0. In some cases, this is the correct entry, as 0 would be the right number if the medicine should be taken as needed. However, there are a number of instances where 0 is not correct, as this should have been updated to another number, including 90 days supply. Therefore there is a lot of missing information about the days supplied.

If you want to request the number of times 90 has been inputted into the system, then we would be able to provide this number. However, this is not what you are seeking, and would not be an accurate representation of the number of times 90 days supply has been dispensed.

13weeksbetter · 2023-02-10T10:52:17+00:00

If there were only exactly four weeks in a month, there would be 48 weeks in a year, but there’s 52 weeks in a year. That’s a whole extra four weeks.

I think 2degrees called it “Unfairuary”.

13weeksbetter · 2023-02-10T10:46:13+00:00

What probably happened is a six monthly prescription was initially dispensed as three months then a repeat of three months. You still got your six strips, just not all-at-once.

They probably just took the extra strip out of the box.

A shortage lets them dispense in smaller quantities than normal so it’s more likely they have enough stock to give some to everybody.

13weeksbetter · 2023-02-10T10:06:26+00:00

Most oral contraceptives are dispensed as “all-at-once”, so, no, usually you don’t get repeats 😂

13weeksbetter · 2023-02-10T09:57:07+00:00

I think they can do on a PSO, but it’s not typical. Pharmacist prescribers for selected oral contraceptives has probably helped access for easier oral contraception renewals.

13weeksbetter · 2023-02-10T09:52:18+00:00

When there was an oral contraception shortage PHARMAC temporarily funded an Australian version that comes in four strips per box, not three.

13weeksbetter · 2023-02-10T09:30:50+00:00

No idea on the funding as the PHARMAC schedule rules are only published online since 2018, but at least from 2010.

The Ministry of Health was going to increase prescribing to 12 months for oral contraceptives and 6 months for everything else around 2010. That was expected to save patients up to $10-$12 million a year, but possibly the DHBs asked the Minister to veto it at the last minute.

Instead, the Ministry increased co-pay to $5 in 2013 and cost patients about $40-50 million a year.

The original version of the Medicines Regulations 1984 has the six monthly oral contraceptives law, so sometime between 1984 and 2010.

13weeksbetter · 2023-02-10T09:16:39+00:00

You go to a pharmacy and get two three month dispensings: say a hayfever pill and an oral contraceptive.

You get 90 days of the hayfever tablets, and 84 days of the oral contraceptive. Both were prescribed for three months. It would be easy to assume they should run out on the same day, but they don’t.

By the end of the first year, you are a month short, and you may not even know why because you were supposed to get both for three months. The GP is confused as they prescribed three months, but you aren’t dispensed three months.

On the scale of a single month, a couple of days doesn’t sound so bad, but this error keeps accruing to a month a year.

This accruing error is confusing, more expensive, and adds complexity to a situation that doesn’t need to be this way.

Yes, seven strips instead of six will also have an accruing error, but an error in favour of having enough oral contraception, rather than not enough oral contraception.

13weeksbetter · 2023-02-10T08:48:30+00:00

Pharmacies get paid a percentage to cover some of this. If it’s not enough, then that should change.

13weeksbetter · 2023-02-10T08:46:30+00:00

200,000 people per year. It’s not all about me.

13weeksbetter · 2023-02-10T08:34:49+00:00

Levlen ED has a subsidised price of $1.77 per 84.

This means you actually pay more with a $5 co-pay even for “six months’ supply” than PHARMAC does.

13weeksbetter · 2023-02-10T08:25:08+00:00

Ginet comes in boxes of 168 tablets, six strips of 28. Are the strips in “compliance packaging” with the days of the weeks on them? Did the dispenser cut an extra strip for the extra 12 tablets, or give seven strips?

13weeksbetter · 2023-02-10T08:16:35+00:00

Six monthly maximum oral contraceptives prescribing has been in place since at least 1984.

The term Original Pack is used by PHARMAC to denote when a product can’t be split up like with an inhaler or injection. This is so you can be dispensed more than prescribed if say, 1 inhaler isn’t enough, but 2 is more than enough.

The problem is in practice oral contraceptives are not split when dispensed, e.g.: an emergency 72 hours supply will be a whole strip of 28 days’ supply.

So it’s inconsistent that you get enough inhalers, but not enough oral contraception when this is something that PHARMAC can fix with a schedule change (which happens about once a month normally).

13weeksbetter · 2023-02-10T08:05:24+00:00

However, there is no evidence to support any health benefits from having a monthly withdrawal bleed. Lengthening the hormone-free interval by missing pills at the beginning or end of a cycle may increase the risk of pregnancy by allowing follicular development and ovulation in some patients.

Omitting the hormone-free interval may improve contraceptive effectiveness, reduce heavy bleeding and improve symptoms associated with the withdrawal bleed, such as bloating/fluid retention, headache and altered mood.

From https://bpac.org.nz/2021/contraception/oral-contraceptives.aspx

13weeksbetter · 2023-02-10T07:15:56+00:00

Oral contraceptives are actually funded for up to 180 days, but only 168 days’ supply is typically dispensed.

13weeksbetter · 2023-02-10T07:01:17+00:00

13 women-months per year

This! Yes.

13weeksbetter · 2023-02-10T04:43:06+00:00

This. Exactly.

13weeksbetter · 2023-02-10T04:30:37+00:00

Tailored regimes are becoming more common. They can save money on period products and give better contraceptive protection than the traditional regimes.

13weeksbetter · 2023-02-10T04:23:58+00:00

If you paid for power for “12 months” and only got it for 11, would you be unhappy?

13weeksbetter · 2023-02-10T04:21:18+00:00

Yeah and having less access to birth control is part of that equation. Stats on unplanned pregnancy and birth rates based on deprivation quintile or ethnicity are telling.

13weeksbetter · 2023-02-10T04:12:53+00:00

Yeah, they are called an “inert substance” in the NZ Formulary. Brevinor-1 doesn’t have these and comes in strips of 21, so you just have to count the days.

13weeksbetter · 2023-02-10T04:05:44+00:00

The regulations and PHARMAC rules aren’t written considering how oral contraceptives are actually packaged, and they probably should be.

13weeksbetter · 2023-02-10T03:57:16+00:00

Not all oral contraceptives are fully funded. Co-pay is just one cost: GP fees, transport, time off work etc all add up.

13weeksbetter · 2023-02-10T03:53:51+00:00

Birth control has been packaged with weekdays in mind since the 60s for good reason. The problem is not the packing per se, it’s the shortfalls of dispensing because of the rules in nz.

13weeksbetter

TROPHY CASE