Evidence Intelligence · PHARMAC PTAC Analysis

What PHARMAC's PTAC recommendations actually tell us

Analysis of 158 PTAC recommendations across 27 PTAC meeting records from 2020 to 2025. Extracted directly from published minutes — no modelling, no assumptions.

⚠ Not peer reviewed · For informational purposes only · © 2026 Ascentra Medical Limited
0
PTAC recommendations analysed
0
Unique medicines reviewed
5
Years of PTAC records
0
Therapy areas covered
Slide 02 · The Funding Landscape

PHARMAC funds most medicines — but not unconditionally

Of 158 decisions reviewed, 64% resulted in unPTAC recommended with conditions. The 13% conditional rate is the most commercially significant outcome — every conditional decision is a funded position with a widening pathway.

101
64%
Recommended
PTAC recommended
31
20%
PTAC did not recommend
Evidence insufficient
21
13%
Conditional
PTAC recommended with conditions
5
3%
Deferred
Awaiting evidence

Decisions by year

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Recommended
Conditional
PTAC did not recommend
Key finding

Cost-effectiveness concern leads to PTAC recommended with conditions — not rejection. PHARMAC manages CE uncertainty through access criteria, not denial.

21 of 21 conditional decisions had a CE concern attached
Slide 03 · The Evidence Concern Map

Four evidence patterns. Four predictable outcomes.

The corpus reveals consistent relationships between evidence gap type and funding outcome. These patterns are not exceptions — they are the rule across five years of decisions.

Low certainty evidence
112 decisions · 71%
→ PTAC recommended with conditions
PHARMAC accepts uncertainty and manages it through criteria. This is the dominant funding pattern — not "wait for better evidence" but "fund now with conditions."
So what: Expect PTAC recommended with conditions. Design for criteria widening post-approval, not broad access from submission.
Indirectness mismatch
7 decisions · 4%
→ 100% PTAC did not recommend
Surrogate endpoints, indirect comparisons, or population mismatches — hard rejections across five years. No conditional outcomes. No exceptions.
So what: Indirectness is a structural barrier. CE modelling cannot overcome it. Invest in direct survival evidence before submission.
Absent evidence
36 decisions · 23%
→ Context dependent
Accepted in rare disease where unmet need is established. Deferred in contested indications. Context — not the gap itself — determines outcome.
So what: In rare disease, lead with need. In standard indications, absent evidence carries deferral risk.
Equity evidence gap
3 decisions · 2%
→ Funded but incomplete
Medicines funded for general populations while Māori and Pacific access remains structurally unresolved — not because PHARMAC rejected equity, but because it wasn't submitted.
So what: The liraglutide precedent shows PHARMAC will operationalise equity criteria. Five therapy areas have not used it.
Slide 04 · Therapy Area Matrix

Each therapy area faces a different standard

CE scrutiny in immunology is not the same as CE scrutiny in rare disease. The evidence standard is category-specific — not universal. Click a card to expand.

${[ {name:'Oncology',n:28,pct:'64%',pctColor:'amber',badges:[{t:'64% funded',c:'badge-amber'},{t:'Indirectness = rejection',c:'badge-red'}],signal:'⚠ Zero equity signals — highest unmet need gap',detail:'All 7 indirectness rejections are NOT_RECOMMENDED — 100% reject rate. Three decisions deferred awaiting OS data. CE concern in only 2 decisions — oncology rejections are driven by evidence quality, not cost.'}, {name:'Rare Disease',n:12,pct:'83%',pctColor:'green',badges:[{t:'83% funded',c:'badge-green'},{t:'Low CE scrutiny',c:'badge-blue'}],signal:'',detail:'Absent evidence accepted when unmet need is established. PHARMAC applies a need-based standard — CE models are not outcome-determinative. The one rejection (deflazacort) was on comparative effectiveness grounds.'}, {name:'Immunology & Rheumatology',n:19,pct:'79%',pctColor:'green',badges:[{t:'79% funded',c:'badge-green'},{t:'21% CE concern',c:'badge-red'}],signal:'',detail:'Highest CE challenge rate of any major therapy area. Adalimumab biosimilar restructured category pricing — all subsequent biologic submissions measured against biosimilar reference price.'}, {name:'Neurology',n:13,pct:'92%',pctColor:'green',badges:[{t:'92% funded',c:'badge-green'},{t:'31% conditional',c:'badge-amber'}],signal:'',detail:'Highest funding rate of any major therapy area. MS criteria-gating is the dominant pattern — high funding rate, heavily restricted access. CE concern in 31% of decisions.'}, {name:'Diabetes & Metabolic',n:8,pct:'62%',pctColor:'amber',badges:[{t:'62% funded',c:'badge-amber'},{t:'★ Equity signals',c:'badge-amber'}],signal:'★ Only therapy area with equity evidence — liraglutide landmark',detail:'The liraglutide BMI threshold decision is the corpus landmark for equity-adjusted access criteria — Māori/Pacific-specific threshold recognising differential cardiometabolic risk. Zero CE concerns despite high drug costs.'}, {name:'Respiratory',n:9,pct:'78%',pctColor:'green',badges:[{t:'78% funded',c:'badge-green'},{t:'NZ applicability gap',c:'badge-blue'}],signal:'⚠ Highest asthma rates in Māori/Pacific — zero equity submissions',detail:'Global evidence without NZ population relevance drives rejections. Both rejections (fluticasone furoate/vilanterol, macitentan) on CE and NZ applicability grounds.'}, {name:'Mental Health',n:3,pct:'0%',pctColor:'red',badges:[{t:'0% funded',c:'badge-red'},{t:'Esketamine ×3',c:'badge-red'}],signal:'⚠ 100% rejection — same strategy, same outcome across 4 years',detail:'Esketamine reviewed three times across 2020 and 2024. Same CE uncertainty and RWE gaps in each review. No equity argument advanced. The only therapy area with zero funded medicines over five years.'}, {name:'Cardiovascular',n:4,pct:'100%',pctColor:'green',badges:[{t:'100% funded',c:'badge-green'},{t:'50% CE concern',c:'badge-amber'}],signal:'',detail:'All 4 decisions funded but 2 conditional. Polypill (Trinomia) conditional twice — budget impact uncertainty from breadth of secondary prevention eligibility. CE managed through criteria.'}, ].map(ta => `
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${ta.n} decisions
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${ta.signal ? `
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`).join('')}
Slide 05 · The Multi-Review Pattern

What repeated reviews reveal

15 medicines were reviewed more than once. Two completely different trajectories — determined entirely by whether the evidence gap was closed between submissions.

✓ Progressive access widening — evidence gaps resolved
${[ {drug:'Upadacitinib',n:'10 reviews',detail:'Progressive indication expansion across rheumatology — RA, PsA, AS, atopic dermatitis, Crohn\'s, UC. Each review added a new funded indication.'}, {drug:'Empagliflozin',n:'4 reviews',detail:'Iterative access widening across HbA1c thresholds, culminating in Māori/Pacific equity-linked expansion. The access widening model in practice.'}, {drug:'Vedolizumab',n:'3 reviews',detail:'Conditional to widened access as post-marketing RWE accumulated. Budget impact uncertainty resolved over time.'}, {drug:'Naloxone nasal spray',n:'3 reviews',detail:'Opioid overdose reversal — progressive access widening across community and clinical settings.'}, ].map(r => `
${r.drug}
${r.n}
${r.detail}
`).join('')}
✗ Persistent rejection — evidence gaps not resolved
${[ {drug:'Esketamine',n:'3 reviews',detail:'Same CE uncertainty and RWE gaps across all three reviews (2020 ×2, 2024). No equity argument advanced. Pattern unbroken.'}, {drug:'Apalutamide',n:'2 reviews',detail:'Both deferred awaiting OS data. Not rejected — evidence pending. Same gap, same deferral.'}, {drug:'Atezolizumab',n:'2 reviews',detail:'Indirectness mismatch in both reviews. OS data from different population. Pattern unresolved between submissions.'}, ].map(r => `
${r.drug}
${r.n}
${r.detail}
`).join('')}
Slide 06 · The Equity Access Map

Where the evidence is silent

Of 158 decisions, 3 explicitly engaged with Māori or Pacific population access. Not because equity is irrelevant — because equity evidence was not submitted.

3
of 158 decisions
with equity signals
Empagliflozin
Type 2 diabetes — HbA1c threshold removal
Access widening for Māori/Pacific — each review progressively reduced the threshold. Budget impact of uptake uncertain.
Sildenafil
Erectile dysfunction — access widening
High-deprivation population access — eligibility expanded to include socioeconomic criteria.
★ Corpus landmark
Liraglutide
Weight management — BMI 50+ Māori/Pacific with CVD risk
The only decision in 158 where equity evidence drove the primary access criteria. PHARMAC set a Māori/Pacific-specific BMI threshold recognising differential cardiometabolic risk.
Therapy areas with zero equity evidence submitted (2020–2025)
${['Oncology — known Māori/Pacific cancer disparities','Immunology & Rheumatology — higher inflammatory disease rates','Neurology — elevated neurological burden','Respiratory — world-leading Māori/Pacific asthma rates','Mental Health — significantly elevated treatment-resistant depression'].map(t => `
${t}
`).join('')}
Slide 08 · Research Priorities & Recommendations

What the corpus says is needed

Important disclaimer: The following research priorities are derived from documented PTAC decision patterns in published minutes (2020–2025). Evidence availability for specific medicines has not been independently verified. These are pattern-based observations, not confirmed evidence assessments. This analysis has not been peer reviewed.
${[ {n:'01',color:'#DC2626',title:'Head-to-head survival evidence in oncology',body:'7 oncology rejections on indirectness grounds — all need direct OS comparisons vs funded NZ standard of care. Whether existing trial data addresses this requires medicine-specific verification.',tag:'Evidence gap: Indirectness'}, {n:'02',color:'#7C3AED',title:'Māori/Pacific subgroup data across all therapy areas',body:'Zero equity evidence submitted in 5 major therapy areas despite known health disparities. Whether this data exists in trial databases or NZ registries is an open research question.',tag:'Evidence gap: Equity evidence absent'}, {n:'03',color:'#D97706',title:'NZ-specific real-world evidence for conditional medicines',body:'21 conditional decisions have CE conditions attached. Post-marketing NZ RWE could support criteria widening — availability varies by medicine and indication.',tag:'Evidence gap: Low certainty'}, {n:'04',color:'#0369A1',title:'Mental health: NZ effectiveness and equity evidence',body:'Esketamine rejected three times on CE and RWE grounds. No NZ-specific study exists for treatment-resistant depression in Māori/Pacific populations — the untested evidence pathway.',tag:'Evidence gap: Low certainty + equity absent'}, ].map(r => `
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