Control of drug utilization in the context of a national health service: The New Zealand system

A national health service, which includes government payment for pharmaceuticals, has existed in New Zealand for over thirty years. In terms of clinical pharmacology, its most distinctive feature is that for most of this time there was no control over the access of drugs to the market. Instead, powerful control has always been exerted at an alternate point; namely, the manner in which drugs are utilized in general practice. These controls over utilization stem from the conditions required to obtain reimbursement of drug costs from the government. The controls include restriction of some drugs to hospital pharmacies, restriction to specialists, restriction to use in approved indications, and limits to the duration of supply on a single prescription. The effectiveness of some of these measures has been demonstrated experimentally. Their success probably depends on the existence of a relatively structured system of medical care, particularly with regard to general practice. Controls over drug utilization appear to be a valid and growing alternative to controls over the access of drugs to the market. Since they generally originate from a different source (third‐party payment), the criteria on which decisions are made are more subtle than the “simple” criteria of safety and efficacy customarily demanded by agencies that regulate the access of drugs to the market. Other features of interest in New Zealand include the prOVision of information on clinical pharmacology and therapeutics from sources independent of the pharmaceutical industry; namely, the government and an independent company.