All the problems with Govt’s cancer drugs campaign promise
The National Government campaigned on funding a list of drugs for 13 different cancers. But those tasked with writing and updating the list say it was never meant to be political.
The Cancer Control Agency is distancing itself from the National Party’s promise to fund new cancer treatments, saying the advice it is based on was never meant to be a shopping list.
The list of treatments became part of National’s election promises last August, lifted from a 163-page analysis, Understanding the Gap, released by Te Aho o Te Kahu – Cancer Control Agency in April 2022. It said it would pay for them by axing free prescriptions for all.
The Cancer Control Agency’s clinical advisory team manager, Bridget Kerkin said the analysis was meant to “contribute to discussion about differences in access to medicines ... not intended to produce a list of medicines that the government, or Pharmac, must fund”.
Oncologist Dr Chris Jackson, one of an international group of clinicians who worked on the report, put it more bluntly: “It was not a wish list. We were saying that was the gap of very good and excellent drugs Australia has that we don’t ... irrespective of cost.”
Health Minister Dr Shane Reti confirmed to The C-Word in March that the list “may change” following warnings from clinicians that the list was out of date, that it excluded blood cancers, and that naming drugs in an election campaign could see drug companies inflate the price.
The Cancer Control Agency has since been tasked with providing updated lists, both on solid tumours and blood cancers, with a deadline of June 30.
Reti would not answer direct questions on whether the revised list would be made public, how many people would benefit and whether he accepted some New Zealanders might stop picking up prescriptions if $5 fee returns.
“I’m continuing to take advice from officials including the Cancer Control Agency on these treatments and the wider work needed in the cancer diagnosis and treatment space,” he said.
As the list continues to pass through the wheels of politics and bureaucracy, a man whose life was saved by an unfunded drug has one message for those making decisions: “Get on with it,” Derek Quilliam, 77, said.
The Clive resident has had three different types of cancer, which have taken his ear, his ability to blink in one eye and left his mouth drooping.
Over the course of 14 years he’s had 20 operations. In 2017, he ran out of funded options when his head and neck cancer “came back big time” and he was unable to tolerate more radiation therapy.
He was told he would need three courses of Keytruda, at $10,000 per course. The drug killed the cancer cells in two.
“It was an absolute silver bullet. If I hadn’t had it, there was nothing else they could do.”
Pharmac funds Keytruda (pembrolizumab), for advanced melanoma and some metastatic lung cancer. There are nine more applications for pembrolizumab that Pharmac wants to fund when its budget allows.
Just one pembrolizumab application, for bladder cancer, is on the Government’s list of 13 cancer therapies.
In total, six of the treatments on National’s list are already on Pharmac’s wishlist. Three have already failed to survive Pharmac’s cost-benefit scrutiny in the past. Pharmac has never received an application for three others on the list.
“There may be drugs that were highly effective, but stupidly expensive, and funding them would suck your entire budget and prevent you from doing other stuff,” Jackson said of the original list.
That’s because the drugs that National promised to fund are tested against the European Society of Medical Oncology (ESMO) Magnitude of Clinical Benefit Scale – a tool that looks at effectiveness, not cost.
Kerkin confirmed the analysis did not consider cost, nor did it model the number of New Zealanders that might benefit from the medicines.
Reti confirmed the Government still planned to fund the drugs through targeted prescription fees. Jackson labelled this funding plan “grotesque”.
His comments were echoed by pharmacist Gemma Perry, spokesperson for the Prescription Access Initiative, who said National’s policy was “taxing one group of sick people to pay for another group of sick people”.
“It’s really unfair for cancer patients that they have to wait for money to be raised through this mechanism.”
Perry has been trying to meet Reti for months to urge him to reconsider axing free prescriptions and he has refused, telling Perry National’s plan to target free fees to low incomes and pensioners would
“It was an absolute silver bullet. If I hadn’t had it, there was nothing else they could do.”
Derek Quilliam
“maintain access ... for some of those who most need assistance”.
Perry flagged the wording of “some people”. “Why did they decide people aged 65+ are deserving but not two minimum wage workers with two children?”
Pharmac’s pharmaceuticals director Geraldine MacGibbon said the agency had funded 13 new cancer drugs and widened access to 13 others in the past five years.
The decisions have helped 6400 New Zealanders, she said.
At the moment, 43% of the 140 applications on its wish list are for cancer treatments.