3 Apr 2019

Breast cancer drug funding: Pharmac, pharmaceutical companies at odds

8:51 pm on 3 April 2019

Major drug firms attacked Pharmac today saying breast cancer patients are dying while they await life-prolonging cancer drugs, but the agency says its funding decisions are based on evidence.


Pharmac prioritises and negotiates funding for drugs in New Zealand's healthcare system. (file photo) Photo: CC BY-NC 2.0 Gatis Gribusts

Parliament's health select committee is considering a petition by Terre Maize seeking funding for two drugs for advanced breast cancer: Kadcyla and Ibrance.

The petition, signed by almost 34,000 people, was presented to Parliament in October last year.

Drug firm Pfizer New Zealand told MPs 3300 women are diagnosed with breast cancer a year in this country and 600 who have advanced cancer die from it.

The firm's senior regional manager for Australia and New Zealand, Justin Binko, said they applied for Ibrance to be funded on the Pharmaceutical Schedule in June 2017.

He said more than 120,000 people around the world take the drug, which provides significant extra time for them.

"The best single-agent anti-hormonal therapy that we have, that has been studied in dozens of clinical trials, demonstrates a progression-free time of about 12 to 15 months. Ibrance doubles this," he said.

He said the drug delays the need for chemotherapy by almost a year.

"New Zealand women deserve better treatment options than are currently available to them."

"Current options are very limited and centred around single-agent anti-hormonal therapy or chemotherapy. However, these options are inadequate and they fall far short of what we could and should be offering to our New Zealand breast cancer patients."

Director for access and public safety Angela Pantano for pharmaceutical company Roche said it was a "sad reflection" on the health system that a petition was needed.

She said Pharmac processes required a full, independent and external inquiry, but it needed a bigger budget to fund innovative medicines, "not just generics".

Ms Pantano said other countries, including Australia, valued lives and therefore funded Kadcyla for Her2-positive breast cancer, an aggressive form.

"Other countries are willing to pay for innovation," she said.

"We don't understand why the life of a person in Australia, the UK, Ireland or Canada for example, is considered more valuable than the life of a Kiwi."

She said Pharmac's priorisation list for funding should be public.

"While we understand that not all details on the list can be shared for commercial confidentiality reasons, at least the order can be shared and commercial decisions made to withdraw the submission - for example if a particular product was so far down the list it was never going to be funded."

She questioned why an estimated $200 million in savings - earned over four years on medicines through Pharmac's processes including tendering - should have been returned to public coffers rather than being spent on more medicines.

"While we understand how those savings have been created, by combining the hospital medicines list and the CPB [community pharmaceuticals], the fact still remains that Pharmac forewent the opportunity to fund up to $50 million of medicines every year. People in New Zealand are dying while waiting for treatment."

Ms Pantano said 41 New Zealanders were paying $6500 including GST for a three-week cycle of Kadcyla, with every fourth cycle free, and the cost to the patient capped at $72,450. Ms Pantano said Pharmac gets "significantly cheaper" products, but there is a "two-tiered system" that increased health inequality.

Pharmac chief executive Sarah Fitt defended their processes, saying they were extremely detailed and meticulous.

She said funding of the products "comes back to the evidence".

"We've seen in a lot of these cases that the evidence looks promising, but our clinicians on our committees do not believe that in many cases the evidence justifies the prices that have been asked."

She said when Pharmac does see benefits, it can move quickly to fund a drug. She also said the agency had good working relationships with many of its drug suppliers.

She also spoke specifically about Kadcyla and Ibrance.

"These medicines are coming with a sort of low-medium priority but quite a high price tag. We have other medicines who have a higher priority that we will actually be looking to fund more quickly."

Pharmac chair Steve Maharey said the call for a fundamental review of the agency was "probably misplaced".

He said the general model New Zealand had adopted was effective, and time spent studying it could be better spent on "cutting issues".

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