Many New Zealanders and their families built their hopes up that last week’s Budget would fund new cancer drugs to help them live longer or live better.
Was the policy a good one in the first place? Could National have delivered it without undermining Pharmac? What’s the truth behind the fiscal cliff?
Hardly a week goes by where we don’t hear a heart-wrenching story of someone affected by cancer who needs a cancer drug to extend their life. People set up Givealittle pages, cash in their KiwiSaver, remortgage their houses, or too often just go without.
We haven’t had a new drug funded for bowel cancer for 20 years, we’re missing out on melanoma drugs that can cure people even when the cancer has spread to the brain, and lung cancer drugs have revolutionised the outlook for thousands with “driver mutations”, and we’re several layers behind international best standard.
In April 2022 the Cancer Agency Te Aho o Te Kahu published a report, which I helped to write, looking at the gap in medicines between Australia and New Zealand. We wanted to give some context to the discussion which includes high emotions among many because their lives are at stake. We used an internationally accepted tool to grade the quality of the drugs and found that Australia had 20 very good or excellent medicines that we didn’t.
We didn’t include blood cancers because the international ranking tool didn’t exist at the time for blood cancer drugs.
We compiled the list based on availability at July 1, 2021 (because you have to choose a date, and writing a report takes time). That was more than two years before National announced their policy, so it was out of date on the day the policy was announced. The gaps list hasn’t been updated since, and there’s no doubt it’s got bigger.
I want people affected by cancer in New Zealand to have better access to cancer drugs. But you can’t give big Pharmac a blank cheque, and you must have a fair process to decide how the drugs are chosen.
At the time I said National was wrong to announce a list of drugs they would fund for several reasons.
First, politicians shouldn’t decide what drugs to fund. Otherwise, those who tell their stories the best by lobbying or through the media will get the funding, while those who don’t will miss out. That’s fundamentally not fair.
By announcing funding for cancer medicines, it also means that cancer would leapfrog all other drugs for all other conditions, no matter if they helped people more.
Also, by announcing a list of drugs that they’d fund, they put Pharmac in a difficult position at the negotiating table - what drug company would lower their prices when they know the Government is already on the hook guaranteeing funding? Pharmac is expert at leveraging prices down by playing companies off against each other, and that gets the taxpayer a better deal (and more drugs as a result).
Pharmac is by law independent from their minister when it comes to which drugs they fund. National knows that, because John Key campaigned on funding Herceptin in the 2008 election campaign, and then had to set up a separate funding mechanism outside Pharmac when he got into government. Of note, Nicola Willis was working for John Key in 2008.
So it was always a strange policy, with a lot of fish hooks. However, they promised the public they would fund more cancer drugs in year one, and some people will have based their vote on that promise.
They could have set up a separate cancer drugs fund, as they do in the UK. They could have lifted Pharmac’s baseline budget and allowed Pharmac to choose the drugs. Ultimately, they decided to kick the issue to touch, and focused on other priorities.
Willis said they had no money after Labour left a “fiscal cliff”. She argued that Labour only funded Pharmac in four-year blocks and they had to restore baseline funding. I find that argument unconvincing, as funding Pharmac in blocks is politics as usual - Jonathan Coleman did the same in the 2016 Budget and Helen Clark’s government did the same before that. It’s no secret that it’s funded this way, and it’s a typical political trick of announcing “new” funding for Pharmac when it’s really just continuing existing commitments.
The problem of cancer medicines isn’t going away. Pharmac’s funding of $1.7 billion is now more than double what it was in 2016. Despite that, this is the first Budget in many years that hasn’t given Pharmac “new” money for new medicines, and many people will be disappointed by that.
None are more disappointed than the people coming to my clinics every week, hoping that a drug that they need would have been funded in this Budget. For many with cancer, next year’s Budget will be too late.
• Christopher Jackson is Professor of Cancer Medicine at the University of Otago and a medical oncologist at Te Whatu Ora - Southern.
- This opinion piece was first published by Newsroom
