PHARMAC decision strengthens rural emergency care

Following PHARMAC’s decision to fund additional medicines for use in community settings, including treatments for trauma and medical emergencies, and ketamine for palliative care – Hauora Taiwhenua says the change will materially strengthen urgent care in rural Aotearoa.

For Clinical Director Rural Health, Dr Rebekah Doran, the announcement reflects both clinical necessity and sustained rural advocacy.

“In rural practice, time and distance matter,” she says. “When transfer to hospital can take an hour or more, what you have available in the clinic, the home, or at the roadside can directly influence an outcome.”

The decision includes funding for methoxyflurane for emergency pain relief, IV tranexamic acid for trauma and postpartum haemorrhage, and ketamine for intractable pain in palliative care.

Dr Doran says funded access to methoxyflurane is a meaningful addition for PRIME services.

“Some rural PRIME sites have previously purchased methoxyflurane themselves because they could see the immediate benefit for patients in acute pain. National funding recognises its clinical value and removes that cost pressure from local services.”

The availability of IV tranexamic acid for midwives and PRIME practitioners is particularly significant. Evidence shows tranexamic acid reduces mortality when administered early in cases of severe bleeding, with benefit decreasing as time to treatment increases.

“For rural midwives managing postpartum haemorrhage, sometimes during home births far from hospital, early access to tranexamic acid has the potential to save lives,” Dr Doran says. “This strengthens the safety net for wāhine and their whānau in isolated settings.”

Ketamine for severe, intractable pain in palliative care, while expected to be used infrequently, will also make a critical difference when required.

“It is especially positive that aged residential care facilities can hold stock,” she says. “That improves after-hours access and supports people in rural communities who wish to remain close to home at the end of life.”

Dr Mike Loten, GP at Raglan Medical and PRIME provider, says the decision also addresses a long-standing funding gap for rural practices.

“Prior to this decision, PRIME funding didn’t include these medications, which meant practices had to subsidise the service themselves if they wanted to provide a comprehensive emergency response,” he says.

For some services, including Raglan, the medicines were already being purchased locally to ensure patient safety.

“In our case, we were already buying them because we felt they were essential. This decision won’t change what we provide – but it removes that financial pressure and makes the service more sustainable.”

On equity, Dr Loten is pragmatic.

“It’s a small step in the right direction towards getting adequate funding and resources for rural services.”

For years, rural clinicians have worked with more limited access to certain emergency medicines than their hospital-based colleagues. In communities where ambulance response and transport times are longer, delays in treatment can compound existing health inequities.

Dr Doran says this funding decision is a tangible shift toward narrowing that gap.

“People living rurally should not experience poorer outcomes simply because of geography. Expanding access to essential medicines in community settings moves us closer to equitable urgent and emergency care.”

Hauora Taiwhenua made a submission during PHARMAC’s consultation process, strongly supporting the introduction of these medicines.

“We emphasised the need for comprehensive education and clear clinical guidance so primary care clinicians can use these medicines safely,” Dr Doran says. “We also highlighted the importance of monitoring medication use, clinical outcomes and any adverse events within PRIME, with appropriate information-sharing across Health New Zealand, ambulance services and clinicians.”

She says the organisation was encouraged that these considerations were acknowledged and referred to the appropriate agencies.

Dr Loten agrees that the broader principle must continue.

“We need to keep rural proofing as a necessary step in all funding decisions. Rural communities can’t be an afterthought.”

Dr Doran says the decision signals growing recognition of the role community-based services play in delivering urgent care across rural Aotearoa.

“This is a practical shift that supports clinicians on the ground and improves safety for rural communities,” she says. “National funding decisions must reflect the realities of rural practice.”

Hauora Taiwhenua will continue to work alongside clinicians, communities, and decision-makers to ensure rural services are equipped with the tools they need to deliver safe, high-quality care – wherever that care is needed.