I paid $70,000 but same cancer was treated for free
They have the same form of cancer and a breakthrough drug has saved their lives.
But in a jaw-dropping discrepancy, one was treated for free and the other paid more than $70,000 for the medicine.
The stories of Graham Page and Ian Hart highlight a major failure of our drug subsidy scheme, which lags the world in funding lifesaving immunotherapy treatments Keytruda and Opdivo. The Therapeutic Goods Administration (TGA) has approved Keytruda for 26 cancer types, but it is funded by our medicines subsidy scheme for only 15.
Graham Page, 84, has bowel cancer with a gene fault known as mismatch repair deficiency (dMMR). His cancer treatment is subsidised by the government.
Ian Hart, 76, also has cancer with the same dMMR gene fault, but his cancer is in the pancreas and Keytruda is not funded for use in pancreatic cancer. He had to sell his home and spent $7200 every three weeks on the treatment.
Oncologist and Adelaide University Professor Tim Price who treats both men said even though their cancers were in different organs, Keytruda targeted the gene mutation common to them both.
The problem is “you’ve got a (subsidy) system that doesn’t really understand that targeted approach”, he said.
Pancreatic cancer has one of the lowest survival rates of any cancer and, when diagnosed, Mr Hart was told he had just three months to live.
Thanks to the breakthrough drug, he is still alive 11 years on.
He is well enough to play lawn bowls and has been on several trips to Europe.
“I didn’t have that sort of money, so I had to borrow the money until I sold my house,” he said. “Anybody who didn’t have that money. Oh, my goodness. I felt sorry for them,” he said.
He spent $70,000 on the treatment before the pharmaceutical company that makes the drug gave him access for free under a program that caps how much a person spends in a lifetime if they are still responding to the treatment.
Mr Graham, who is well enough to ride his bike 40km twice a week and walks 15km on another two days, said “it’s probably not fair” his treatment was subsidised, but Mr Hart’s was not.
The government committee that decides which medications get a government subsidy has to individually approve a subsidy for each different type of cancer – a process that takes on average 447 days for each indication.
In November, the committee ruled a subsidy for Keytruda across multiple cancers “would be appropriate with a risk-sharing arrangement”, but it said the pharmaceutical company would have to drop the price of the treatment.
The company MSD offered a substantial price cut, but five months on are waiting to hear what more detail the government required to approve funding.
“We look forward to hearing from the Department of Health and PBAC on how we can progress this matter and make Multi-Cancer Funding a reality for Australian patients as soon as possible. We know that patients with cancer often don’t have time to wait, so it’s important we collectively act with urgency to ensure Australians living with cancer don’t miss out on affordable access to immunotherapy,” it said in a statement.
A Health Department spokesman said: “The department remains open to continuing dialogue with the responsible pharmaceutical companies to support them in resolving the outstanding issues so that a broad PBS listing for these medicines can be reconsidered by the PBAC.”
Eleven cancer groups are pleading with Health Minister Mark Butler to support a multicancer funding proposal for this type of immunotherapy.