1 00:00:05,800 --> 00:00:08,799 Speaker 1: Kiota. I'm Chelsea Daniels and this is the Front Page, 2 00:00:09,200 --> 00:00:17,599 Speaker 1: a daily podcast presented by the New Zealand Herald. It 3 00:00:17,640 --> 00:00:19,720 Speaker 1: may have taken a month to get there, but the 4 00:00:19,720 --> 00:00:23,680 Speaker 1: government has fulfilled its promise to fund new cancer drugs. 5 00:00:24,239 --> 00:00:27,200 Speaker 1: Rather than the thirteen promised on the campaign trial, it's 6 00:00:27,240 --> 00:00:31,600 Speaker 1: giving six hundred and four million dollars for fifty four 7 00:00:31,680 --> 00:00:37,360 Speaker 1: new medicines, including twenty six cancer treatments. It's hoped the 8 00:00:37,400 --> 00:00:39,840 Speaker 1: promised cancer drugs will be rolled out within the next 9 00:00:39,960 --> 00:00:43,680 Speaker 1: year and a half, with the first becoming available from October. 10 00:00:44,120 --> 00:00:45,440 Speaker 2: But the back and forth. 11 00:00:45,200 --> 00:00:49,120 Speaker 1: Over national's pre election promise has raised questions about why 12 00:00:49,159 --> 00:00:52,400 Speaker 1: it's so difficult to fund drugs in this country and 13 00:00:52,479 --> 00:00:55,320 Speaker 1: if Farmac is up to the task. Today on the 14 00:00:55,320 --> 00:00:59,000 Speaker 1: Front Page, University of Auckland professor doctor PAULA Lorgelli is 15 00:00:59,000 --> 00:01:02,800 Speaker 1: with us to discuss if our decades old process needs 16 00:01:02,840 --> 00:01:07,679 Speaker 1: a refresh. First off, Paul, can you explain to us 17 00:01:07,680 --> 00:01:09,840 Speaker 1: how the FARMAC model works. 18 00:01:10,319 --> 00:01:14,120 Speaker 3: So it is a process where a pharmaceutical company, but 19 00:01:14,160 --> 00:01:16,440 Speaker 3: it doesn't have to be a pharmaceutical company. It can 20 00:01:16,520 --> 00:01:19,959 Speaker 3: be somebody who sponsors a submission to them and says hey, 21 00:01:19,959 --> 00:01:22,800 Speaker 3: we've got this new technology, we think it should be 22 00:01:22,840 --> 00:01:26,400 Speaker 3: publicly funded, and therefore it comes in with a dossier 23 00:01:26,440 --> 00:01:28,800 Speaker 3: of evidence, and you look at the evidence and you say, well, 24 00:01:29,040 --> 00:01:32,399 Speaker 3: how good is it. Medsafe has already decided it's safe 25 00:01:32,440 --> 00:01:34,759 Speaker 3: to use, and so it says, well, is it better 26 00:01:34,800 --> 00:01:38,360 Speaker 3: than what we already have? And then most things generally 27 00:01:38,640 --> 00:01:41,080 Speaker 3: are better than what we already have, And then it says, 28 00:01:41,160 --> 00:01:43,680 Speaker 3: does it generate more given how much it's going to 29 00:01:43,880 --> 00:01:47,000 Speaker 3: cost us? So obviously also things are more expensive, and 30 00:01:47,080 --> 00:01:49,200 Speaker 3: so they kind of assess value for money by looking 31 00:01:49,280 --> 00:01:52,800 Speaker 3: at the benefits of the intervention over a comparator, you 32 00:01:52,840 --> 00:01:56,000 Speaker 3: know what's currently standard practice, and compare that to how 33 00:01:56,040 --> 00:01:59,200 Speaker 3: much it's going to cost to deliver that new technology 34 00:01:59,240 --> 00:02:03,000 Speaker 3: into the health gaess. If they've got budget, then they 35 00:02:03,040 --> 00:02:06,360 Speaker 3: can fund it. They then consult on it and they 36 00:02:06,400 --> 00:02:11,000 Speaker 3: start price negotiating, and then it's listed available for doctors 37 00:02:11,520 --> 00:02:17,040 Speaker 3: and other prescribers to start prescribing those technologies, those pharmaceuticals. 38 00:02:17,320 --> 00:02:20,280 Speaker 3: If they don't have enough budget, then they might try 39 00:02:20,320 --> 00:02:24,720 Speaker 3: to renegotiate some stuff they already have in their kind 40 00:02:24,720 --> 00:02:27,000 Speaker 3: of shopping basket and trying to get more value of 41 00:02:27,000 --> 00:02:28,799 Speaker 3: what they're already funding, so they can try and fund 42 00:02:28,840 --> 00:02:31,359 Speaker 3: something new. If they can't do that, then they put 43 00:02:31,360 --> 00:02:33,560 Speaker 3: it on something they call it options for investment lists, 44 00:02:33,560 --> 00:02:36,440 Speaker 3: which is kind of like their wish list, and then 45 00:02:36,840 --> 00:02:39,480 Speaker 3: when they do come across more funding because they've been 46 00:02:39,520 --> 00:02:42,000 Speaker 3: able to negotiate a better price elsewhere in the system, 47 00:02:42,280 --> 00:02:44,880 Speaker 3: then they can fund what's on their options for investment lists. 48 00:02:45,600 --> 00:02:51,080 Speaker 3: So it's a really universal way of assessing whether what 49 00:02:51,200 --> 00:02:55,359 Speaker 3: you're purchasing gives the public, herve the taxpayers value for money. 50 00:02:55,639 --> 00:02:59,520 Speaker 1: FIMAC was established in nineteen ninety three. Hey, is this 51 00:02:59,560 --> 00:03:02,400 Speaker 1: the best way of funding medicines? Do you think or 52 00:03:02,440 --> 00:03:04,519 Speaker 1: do you think it's time to rethink the model. 53 00:03:04,720 --> 00:03:08,440 Speaker 3: It's our way of funding medicine. So we're kind of 54 00:03:08,600 --> 00:03:13,640 Speaker 3: unique globally, and that FARMAC has a budget, a fixed budget, 55 00:03:13,760 --> 00:03:16,639 Speaker 3: so if you want to fund a drug, you need 56 00:03:16,680 --> 00:03:18,680 Speaker 3: to be able to pay for it. In other countries 57 00:03:18,680 --> 00:03:22,440 Speaker 3: they have the same evidence based assessment, but for example, 58 00:03:22,440 --> 00:03:25,280 Speaker 3: in the UK, or in England and Wales at least, 59 00:03:25,639 --> 00:03:28,240 Speaker 3: and in Australia for example, they actually will say, oh, 60 00:03:28,240 --> 00:03:31,080 Speaker 3: that delivers value for money and then they'll just pass 61 00:03:31,120 --> 00:03:32,800 Speaker 3: on that cost to the rest of the health system 62 00:03:32,840 --> 00:03:35,200 Speaker 3: so they get funded. So other countries don't have this 63 00:03:35,320 --> 00:03:38,360 Speaker 3: waiting list, and I think it's this waiting list that 64 00:03:38,640 --> 00:03:41,280 Speaker 3: most people take issue with, both in New Zealand and 65 00:03:41,320 --> 00:03:43,920 Speaker 3: many other countries. They legitimate and they can say no. 66 00:03:44,480 --> 00:03:46,760 Speaker 3: So if something is way too expensive and it doesn't 67 00:03:46,800 --> 00:03:50,240 Speaker 3: deliver benefit, then they'd say no. There's a whole bunch 68 00:03:50,280 --> 00:03:54,200 Speaker 3: of ways within that process. You could do a different 69 00:03:54,320 --> 00:03:58,200 Speaker 3: job credibly. Whether that's a better job, I'm not sure. 70 00:03:58,680 --> 00:04:01,760 Speaker 3: And you could look at different things that are valuable. 71 00:04:01,880 --> 00:04:05,520 Speaker 3: So you know, how do we as a country value equity? 72 00:04:05,600 --> 00:04:08,000 Speaker 3: So at the moment, we often just look at efficiency. 73 00:04:08,640 --> 00:04:11,160 Speaker 3: Does it deliver value for money? Maybe we want to 74 00:04:11,200 --> 00:04:15,400 Speaker 3: look at how we distribute that benefit around individuals in 75 00:04:15,600 --> 00:04:17,919 Speaker 3: New Zealand and so we might want to look at equity. 76 00:04:18,160 --> 00:04:20,760 Speaker 3: There might be some other things that we value that 77 00:04:20,880 --> 00:04:24,280 Speaker 3: might come into that kind of value proposition. So there 78 00:04:24,279 --> 00:04:27,320 Speaker 3: are different ways of doing it and they probably are better, 79 00:04:27,839 --> 00:04:31,039 Speaker 3: and it just kind of depends on what you think 80 00:04:31,120 --> 00:04:34,400 Speaker 3: is better and what you think is worth doing. I 81 00:04:34,440 --> 00:04:38,040 Speaker 3: think getting rid of a farmac model and having no 82 00:04:38,080 --> 00:04:41,400 Speaker 3: one to assess value is just a disaster wanting to 83 00:04:41,440 --> 00:04:45,160 Speaker 3: happen because it wouldn't mean we would have no ability 84 00:04:45,200 --> 00:04:47,680 Speaker 3: to price negotiate, because we wouldn't have any evidence to 85 00:04:47,720 --> 00:04:48,640 Speaker 3: price negotiate on. 86 00:04:48,880 --> 00:04:51,920 Speaker 1: We've heard the government's funding up to twenty six new 87 00:04:52,000 --> 00:04:55,520 Speaker 1: cancer treatments alongside twenty eight other medicines as part of 88 00:04:55,560 --> 00:04:58,680 Speaker 1: a six hundred and four million dollar health budget to 89 00:04:58,720 --> 00:05:01,200 Speaker 1: honor a national re election promise. 90 00:05:02,680 --> 00:05:05,239 Speaker 4: Clarrent farm ac estimates so that around twenty six cancer 91 00:05:05,279 --> 00:05:07,840 Speaker 4: treatments in twenty eight other treatments will be funded as 92 00:05:07,880 --> 00:05:10,760 Speaker 4: a result of the bold new package that we're announcing today. 93 00:05:11,160 --> 00:05:13,120 Speaker 4: This will be a mix of new medicines and widened 94 00:05:13,200 --> 00:05:16,120 Speaker 4: access to medicines that are already available. Of the thirteen 95 00:05:16,160 --> 00:05:18,679 Speaker 4: cancer treatments listed in twenty twenty three, up to seven 96 00:05:18,720 --> 00:05:21,360 Speaker 4: will now be included, and remaining treatments will be replaced 97 00:05:21,360 --> 00:05:24,640 Speaker 4: by alternatives just as good or better. This means treatments 98 00:05:24,640 --> 00:05:26,839 Speaker 4: for all the cancer types in the pre election manifesto 99 00:05:26,880 --> 00:05:27,719 Speaker 4: list are covered. 100 00:05:30,360 --> 00:05:34,359 Speaker 1: Should parties really be promising funding for drugs when farmac 101 00:05:34,440 --> 00:05:37,480 Speaker 1: is actually meant to be independent anyway? A flat no. 102 00:05:38,360 --> 00:05:42,279 Speaker 3: They can promise funding more drugs, so they could have 103 00:05:42,400 --> 00:05:46,600 Speaker 3: promised a greater FARMAC budget, but they should never go 104 00:05:46,760 --> 00:05:50,760 Speaker 3: and promise specific drugs or even you know, fund in 105 00:05:50,800 --> 00:05:55,200 Speaker 3: a specific area like cancer, because that's the political undermining 106 00:05:55,279 --> 00:05:59,000 Speaker 3: of the independence is FARMAC. And as soon as you've 107 00:05:59,000 --> 00:06:01,839 Speaker 3: indicated that you want to fund a drug, then that 108 00:06:02,320 --> 00:06:06,240 Speaker 3: company now knows that FARMAC won't be hard price negotiating 109 00:06:06,279 --> 00:06:08,839 Speaker 3: with them, right because they're already showing their hand that 110 00:06:08,839 --> 00:06:10,520 Speaker 3: they want to buy that drug. They'll have to buy 111 00:06:10,520 --> 00:06:14,200 Speaker 3: that drug. Why price negotiate hard? I often use the 112 00:06:14,200 --> 00:06:15,800 Speaker 3: analogy It's like kind of like if you want to 113 00:06:15,800 --> 00:06:18,160 Speaker 3: buy a used car, we already know we want to 114 00:06:18,160 --> 00:06:19,800 Speaker 3: buy it, but we're not going to tell the used 115 00:06:19,800 --> 00:06:22,800 Speaker 3: car salesperson you know what we want to pay for 116 00:06:22,839 --> 00:06:25,520 Speaker 3: it straight up, right, we're going to start negotiating. You 117 00:06:25,600 --> 00:06:28,279 Speaker 3: don't show your hand in that situation. And what the 118 00:06:28,320 --> 00:06:31,200 Speaker 3: government did is it showed its hand and it left 119 00:06:31,440 --> 00:06:35,239 Speaker 3: farmc and that really precarious situation, and the only persons 120 00:06:35,279 --> 00:06:38,960 Speaker 3: to benefit was going to be a pharmaceutical industry and 121 00:06:39,040 --> 00:06:41,560 Speaker 3: obviously patients as well, but at the expense of other 122 00:06:41,640 --> 00:06:44,640 Speaker 3: patients who wouldn't be able to access drugs. 123 00:06:44,960 --> 00:06:47,920 Speaker 1: It almost feels like these other drugs only got funded 124 00:06:47,960 --> 00:06:50,480 Speaker 1: because of these cancer drugs were causing a headache for 125 00:06:50,760 --> 00:06:54,720 Speaker 1: the government. In total, we're getting fifty four new medicines 126 00:06:54,839 --> 00:06:58,000 Speaker 1: available for a raft of situations, including those twenty six 127 00:06:58,279 --> 00:07:01,400 Speaker 1: new cancer treatments. We've also we've seen media campaigns in 128 00:07:01,440 --> 00:07:05,440 Speaker 1: the past push for specific drugs to get funded. Is 129 00:07:05,480 --> 00:07:08,960 Speaker 1: there a worry that whatever gets the most media attention, 130 00:07:09,080 --> 00:07:12,720 Speaker 1: I guess can potentially jump that queue in farmac's wait list. 131 00:07:13,600 --> 00:07:16,760 Speaker 3: No, and that's the beauty of FARMAC being independent. It 132 00:07:16,800 --> 00:07:22,000 Speaker 3: should be independent of anybody's own agenda. And I think 133 00:07:22,040 --> 00:07:25,680 Speaker 3: it's really interesting because we are getting up to the 134 00:07:25,760 --> 00:07:29,600 Speaker 3: key there is up to fifty four new medicines coming 135 00:07:29,640 --> 00:07:33,000 Speaker 3: on to the FARMAC list. That would suggest that one 136 00:07:33,080 --> 00:07:37,080 Speaker 3: of those cancer treatments that they wanted to fund must 137 00:07:37,080 --> 00:07:39,760 Speaker 3: have been a long way down that waiting list and 138 00:07:39,800 --> 00:07:41,960 Speaker 3: it hasn't been bumped up, So it's not just that 139 00:07:42,000 --> 00:07:45,000 Speaker 3: they're given them more money. It sounds to me we 140 00:07:45,040 --> 00:07:45,760 Speaker 3: can't see. 141 00:07:45,520 --> 00:07:46,120 Speaker 1: The list right. 142 00:07:46,120 --> 00:07:49,360 Speaker 3: The list is confidential to FARMAC, but given they're having 143 00:07:49,400 --> 00:07:53,040 Speaker 3: to provide money for fifty four up to fifty four drugs, 144 00:07:53,720 --> 00:07:56,960 Speaker 3: of which only twenty six are for cancer, it would 145 00:07:56,960 --> 00:08:00,480 Speaker 3: suggest that some of those newly funded cancer drug were 146 00:08:00,600 --> 00:08:03,440 Speaker 3: lower on that list. Which would suggest that they were 147 00:08:03,520 --> 00:08:06,520 Speaker 3: given the priority that people thought they should have been given. 148 00:08:07,120 --> 00:08:09,680 Speaker 3: But it was an order that was based on priority 149 00:08:09,720 --> 00:08:12,920 Speaker 3: that farmac's advisory groups decide. 150 00:08:13,040 --> 00:08:15,560 Speaker 1: A review into FARMAC a couple of years ago made 151 00:08:15,640 --> 00:08:19,840 Speaker 1: thirty three recommendations with a focus on the agency's governance 152 00:08:19,880 --> 00:08:23,360 Speaker 1: and accountability, its decision making, and a call there for 153 00:08:23,440 --> 00:08:26,880 Speaker 1: a closer look at cancer medicines and rare disorders. 154 00:08:31,040 --> 00:08:34,120 Speaker 2: The interim report into FARMAC condemns the agency, saying it 155 00:08:34,160 --> 00:08:38,040 Speaker 2: has a fortress mentality that permits little transparency, it's not 156 00:08:38,160 --> 00:08:41,840 Speaker 2: fast enough, saying it appears each funding decision takes as 157 00:08:41,880 --> 00:08:45,559 Speaker 2: long as it takes, it's increasingly disconnected from other parts 158 00:08:45,600 --> 00:08:49,800 Speaker 2: of the health system, and farmac's processes are not patient centered. 159 00:08:53,080 --> 00:08:57,920 Speaker 1: In your opinion, has farmac's decision making processes improved since 160 00:08:57,960 --> 00:08:59,720 Speaker 1: that review, I think it was a couple of years ago. 161 00:09:00,960 --> 00:09:01,040 Speaker 5: No. 162 00:09:01,360 --> 00:09:02,880 Speaker 3: I think it's kind of like trying to turn the 163 00:09:02,960 --> 00:09:06,080 Speaker 3: Titanics a slow moving agency. One of the calls was 164 00:09:06,120 --> 00:09:09,719 Speaker 3: for greater transparency. With this impending announcement and now the 165 00:09:09,760 --> 00:09:13,800 Speaker 3: announcement yesterday, I have been looking into what evidence they 166 00:09:13,800 --> 00:09:17,320 Speaker 3: do produce. It's very scant on evidence compared to what 167 00:09:17,360 --> 00:09:20,199 Speaker 3: you might see in other countries. You know, I've analyzed 168 00:09:20,440 --> 00:09:24,319 Speaker 3: submissions and decisions in other countries, so they're not very transparent. 169 00:09:24,600 --> 00:09:26,959 Speaker 3: I'm not aware that their methods have changed. I know 170 00:09:27,000 --> 00:09:31,800 Speaker 3: their methods are under review for undertaking economic evaluations. So 171 00:09:32,280 --> 00:09:34,640 Speaker 3: I think it's been highlighted that there is a need 172 00:09:34,679 --> 00:09:37,320 Speaker 3: for change, and they're well aware of it. But let's 173 00:09:37,320 --> 00:09:41,640 Speaker 3: suspect what's happening within FARMAC is they're spending their day 174 00:09:41,760 --> 00:09:46,080 Speaker 3: job trying to review medicines and they don't have enough 175 00:09:46,200 --> 00:09:49,840 Speaker 3: kind of airtime headspace to actually think about how do 176 00:09:49,880 --> 00:09:52,360 Speaker 3: we change the way that we review medicines, how do 177 00:09:52,400 --> 00:09:55,840 Speaker 3: we change the way we make decisions. So I would 178 00:09:55,960 --> 00:09:58,880 Speaker 3: hope that in some of this new funding they've received 179 00:09:59,400 --> 00:10:01,920 Speaker 3: give some a little bit of space in which to 180 00:10:02,120 --> 00:10:03,400 Speaker 3: change the way they operate. 181 00:10:13,559 --> 00:10:16,720 Speaker 1: I mean, we constantly hear about New Zealanders looking abroad 182 00:10:16,800 --> 00:10:20,800 Speaker 1: for treatments and fundraising for the treatments they need. What 183 00:10:20,840 --> 00:10:23,360 Speaker 1: are these other countries doing differently? Is it a question 184 00:10:23,520 --> 00:10:26,320 Speaker 1: of the money or is it a question of they're 185 00:10:26,360 --> 00:10:31,359 Speaker 1: just quicker at approving new and up to date medical treatments. 186 00:10:31,800 --> 00:10:36,400 Speaker 3: Yeah, some countries have a fast track process where they 187 00:10:36,480 --> 00:10:39,280 Speaker 3: might say, well, we'll approve this medicine even though we're 188 00:10:39,320 --> 00:10:43,559 Speaker 3: a bit unsure about whether it's effective, and then while 189 00:10:43,760 --> 00:10:47,080 Speaker 3: patients are using it, will assess and evaluate how good 190 00:10:47,640 --> 00:10:49,839 Speaker 3: the medicine is. So it's kind of like extending the 191 00:10:50,000 --> 00:10:53,760 Speaker 3: clinical trial evidence into the real world and therefore patients 192 00:10:53,760 --> 00:10:56,439 Speaker 3: get access and then at the end of that period 193 00:10:56,840 --> 00:10:59,599 Speaker 3: they then use that evidence they've collected as part of 194 00:10:59,640 --> 00:11:02,480 Speaker 3: an new evidence review. So there are different ways there 195 00:11:02,520 --> 00:11:05,360 Speaker 3: where you can kind of fast track access, which works 196 00:11:05,400 --> 00:11:08,680 Speaker 3: as long as you've got then an opportunity to renegotiate 197 00:11:08,720 --> 00:11:13,400 Speaker 3: and revisit the price according to how well they worked 198 00:11:13,400 --> 00:11:16,160 Speaker 3: in the real world. So that's an option that happens 199 00:11:16,200 --> 00:11:18,760 Speaker 3: in other countries that we don't have here in New Zealand. 200 00:11:18,800 --> 00:11:21,400 Speaker 1: Because it does feel like New Zealand is constantly on 201 00:11:21,480 --> 00:11:23,880 Speaker 1: the back foot when it comes to these breakthrough drugs 202 00:11:23,920 --> 00:11:27,360 Speaker 1: available overseas. Does it take too long for drugs to 203 00:11:27,400 --> 00:11:29,280 Speaker 1: be approved in New Zealand or do you think it's 204 00:11:29,360 --> 00:11:31,199 Speaker 1: good to be cautious And I. 205 00:11:31,120 --> 00:11:33,240 Speaker 3: Guess it depends on what's approved. I mean it doesn't. 206 00:11:33,760 --> 00:11:37,520 Speaker 3: They are rigorous and it's important that the evidence is 207 00:11:37,559 --> 00:11:41,120 Speaker 3: addressed with an our Chiro and New Zealand lens because 208 00:11:41,200 --> 00:11:44,840 Speaker 3: our healthcare system is different. What they will be displacing 209 00:11:44,880 --> 00:11:46,800 Speaker 3: the system will be different, so we do need to 210 00:11:46,840 --> 00:11:50,360 Speaker 3: have our own evidence dossier. So there's always a longer 211 00:11:50,400 --> 00:11:53,240 Speaker 3: time doing the evaluation, doing the assessment. That's probably longer 212 00:11:53,280 --> 00:11:56,080 Speaker 3: than other countries, but it's just that the budget is 213 00:11:56,120 --> 00:11:59,160 Speaker 3: not available in FARMAC. So in other countries they'll make 214 00:11:59,200 --> 00:12:03,080 Speaker 3: a decision. In England, the National Institute for health Care 215 00:12:03,120 --> 00:12:06,800 Speaker 3: Excellence makes a decision, so NICE makes a decision, and 216 00:12:06,840 --> 00:12:11,320 Speaker 3: then the NHS funds the decision, so the decision has 217 00:12:11,400 --> 00:12:14,199 Speaker 3: just passed on to somebody else with funding, and then 218 00:12:14,240 --> 00:12:16,280 Speaker 3: the NHS has to find funding. It's not that they 219 00:12:16,280 --> 00:12:18,000 Speaker 3: get more money, so they just have to find it 220 00:12:18,080 --> 00:12:20,880 Speaker 3: in another part of their healthcare system. But we just 221 00:12:20,920 --> 00:12:23,560 Speaker 3: don't have that here, and so the constraint for FARMAC 222 00:12:23,679 --> 00:12:27,240 Speaker 3: is that it's constrained by its budgets, so I think 223 00:12:27,280 --> 00:12:30,160 Speaker 3: it probably makes decisions a little bit slower. But then 224 00:12:30,400 --> 00:12:32,920 Speaker 3: pharmaceuticals then go on this waiting list. 225 00:12:33,760 --> 00:12:36,280 Speaker 1: Ozzie murdered. It was the first medication on their list 226 00:12:36,360 --> 00:12:40,360 Speaker 1: that they promised to fund if they were elected into. 227 00:12:40,160 --> 00:12:43,719 Speaker 5: Government, and that's the medication that I desperately need. I've 228 00:12:43,720 --> 00:12:46,520 Speaker 5: spoken to a former health minister and they say National 229 00:12:46,600 --> 00:12:49,600 Speaker 5: should never have promised this in the first place, because essentially, 230 00:12:49,640 --> 00:12:52,160 Speaker 5: when you name thirteen drugs, it shows your hand and 231 00:12:52,600 --> 00:12:54,600 Speaker 5: allows drug companies to milk it. 232 00:12:56,760 --> 00:12:59,200 Speaker 1: Going back to talking about showing our hand, do you 233 00:12:59,280 --> 00:13:02,679 Speaker 1: think National promising these cancer drugs and then the backlash 234 00:13:02,720 --> 00:13:06,560 Speaker 1: of them not actually being included in the budget has 235 00:13:06,760 --> 00:13:08,600 Speaker 1: ultimately cost us money? 236 00:13:09,000 --> 00:13:12,280 Speaker 3: Well, we're only going to fund something we've already evaluated. 237 00:13:12,400 --> 00:13:17,240 Speaker 3: So I'm not clear now on where the industry won't 238 00:13:17,280 --> 00:13:21,520 Speaker 3: budge on price because we've already declared we were going 239 00:13:21,600 --> 00:13:25,360 Speaker 3: to fund them. So it may be costing us more 240 00:13:25,720 --> 00:13:29,080 Speaker 3: than if they had instead just given Farmac the money 241 00:13:29,840 --> 00:13:32,880 Speaker 3: and not named any drugs. So I suspect we will 242 00:13:32,920 --> 00:13:36,560 Speaker 3: be paying more because they outwardly said we wanted to 243 00:13:36,559 --> 00:13:38,680 Speaker 3: fund thirteen cancer drugs. 244 00:13:38,960 --> 00:13:43,240 Speaker 1: So Bill, what ultimately needs to change? Do governments need 245 00:13:43,280 --> 00:13:46,200 Speaker 1: to put more money into drugs just full stop? Does 246 00:13:46,240 --> 00:13:50,439 Speaker 1: Farmac need a refresh? Is it just both elements? Is 247 00:13:50,480 --> 00:13:52,920 Speaker 1: it something else? How do we stop ourselves from having 248 00:13:53,000 --> 00:13:55,920 Speaker 1: these conversations? I guess every few months, Yeah. 249 00:13:55,679 --> 00:13:59,040 Speaker 3: And we'll continue to have these conversations. See some patient 250 00:13:59,120 --> 00:14:01,240 Speaker 3: advocates have come out and said, you know, we hope 251 00:14:01,280 --> 00:14:03,720 Speaker 3: to not have these conversations again, but we will continue 252 00:14:03,720 --> 00:14:07,079 Speaker 3: to see them because of the fixed budget model of FARMAC. 253 00:14:07,559 --> 00:14:10,440 Speaker 3: So if FARMAC didn't have a fixed budget model, then 254 00:14:10,480 --> 00:14:13,560 Speaker 3: we'd be having potentially lease of these conversations, but we'd 255 00:14:13,600 --> 00:14:17,040 Speaker 3: still then have to have broader conversations about value for 256 00:14:17,120 --> 00:14:21,280 Speaker 3: money and the wider healthcare system. I actually think we 257 00:14:21,520 --> 00:14:24,120 Speaker 3: spend a lot of time talking about a part of 258 00:14:24,120 --> 00:14:28,200 Speaker 3: a healthcare system where which actually spend a small percentage 259 00:14:28,280 --> 00:14:30,880 Speaker 3: of our healthcare budget on It just happens to be 260 00:14:31,040 --> 00:14:33,760 Speaker 3: look large in terms of numbers, but I'm going to 261 00:14:33,760 --> 00:14:36,520 Speaker 3: say it's probably something like ten to fifteen percent, which 262 00:14:36,520 --> 00:14:39,480 Speaker 3: is what it is in many other countries. So I 263 00:14:39,520 --> 00:14:41,240 Speaker 3: actually think we probably need to do a better job 264 00:14:41,240 --> 00:14:44,240 Speaker 3: of understanding how do we spending our money our other 265 00:14:44,360 --> 00:14:46,760 Speaker 3: kind of like eighty five percent in the healthcare system. 266 00:14:47,520 --> 00:14:51,160 Speaker 3: So if we had better access to GPS, maybe we'd 267 00:14:51,160 --> 00:14:54,760 Speaker 3: be more proactive and have more preventative healthcare and we 268 00:14:54,760 --> 00:14:57,600 Speaker 3: wouldn't need people having to go on and have many 269 00:14:57,600 --> 00:15:00,240 Speaker 3: of these high cost drugs. So actually, I think a 270 00:15:00,240 --> 00:15:03,800 Speaker 3: broader conversation about how much do we spend on health 271 00:15:04,000 --> 00:15:06,680 Speaker 3: and are we spending it in the right place. So 272 00:15:07,520 --> 00:15:10,080 Speaker 3: FARMAC is an easy one because there's lots of evidence 273 00:15:10,240 --> 00:15:15,040 Speaker 3: around pharmaceuticals and technologies. But maybe we need to have 274 00:15:15,080 --> 00:15:19,239 Speaker 3: a broader conversation about whether there's evidence around more preventive healthcare, 275 00:15:19,840 --> 00:15:23,000 Speaker 3: the scans we get or the surgeries we get, or 276 00:15:23,040 --> 00:15:26,200 Speaker 3: the access we have to GPS. And I think actually 277 00:15:26,280 --> 00:15:30,920 Speaker 3: having a broader kind of healthcare conversation would mean we 278 00:15:31,000 --> 00:15:34,120 Speaker 3: can probably potentially stop focusing on the ambulance at the 279 00:15:34,120 --> 00:15:36,320 Speaker 3: bottom of the cliff, which is a lot of these drugs, 280 00:15:36,800 --> 00:15:39,960 Speaker 3: and think more about having a healthier healthcare system. 281 00:15:40,240 --> 00:15:44,280 Speaker 1: So, just to confirm Paula, you reckon that FARMAC shouldn't 282 00:15:44,280 --> 00:15:47,520 Speaker 1: have its own independent funding. I guess it should be 283 00:15:47,600 --> 00:15:50,840 Speaker 1: an approval process and then go through the health budget 284 00:15:51,040 --> 00:15:51,840 Speaker 1: like other countries. 285 00:15:52,120 --> 00:15:54,960 Speaker 3: I'm not sure I'm recommending that. Yeah, that would require 286 00:15:55,000 --> 00:15:57,680 Speaker 3: some other things for FARMAC to change that we'd have 287 00:15:57,760 --> 00:16:01,320 Speaker 3: to understand what our threshold would be in terms of 288 00:16:01,320 --> 00:16:03,760 Speaker 3: cost effectness, so that it would require a few steps 289 00:16:03,800 --> 00:16:06,800 Speaker 3: before I went down that recommendation approach. And I'm also 290 00:16:06,960 --> 00:16:10,240 Speaker 3: not sure that that's necessarily any better or worse. Because 291 00:16:10,280 --> 00:16:13,640 Speaker 3: FARMAC does have a fixed budget, it does negotiate very well. 292 00:16:13,920 --> 00:16:16,320 Speaker 3: So the fact that people say, oh, we paid some 293 00:16:16,400 --> 00:16:18,080 Speaker 3: of the least for drugs, I think we should be 294 00:16:18,120 --> 00:16:21,240 Speaker 3: proud of that because that's because FARMAC is doing its 295 00:16:21,320 --> 00:16:25,080 Speaker 3: job so well. If we took away potentially that fixed budget, 296 00:16:25,240 --> 00:16:28,280 Speaker 3: so FARMAC just was passing the costs onto another part 297 00:16:28,280 --> 00:16:31,960 Speaker 3: of the healthcare system, maybe FARMAC wouldn't be so strong 298 00:16:32,160 --> 00:16:35,080 Speaker 3: in a negotiating stance. So it's kind of like, you know, 299 00:16:35,120 --> 00:16:36,200 Speaker 3: where's the balance there. 300 00:16:36,320 --> 00:16:39,440 Speaker 1: So just finding that balance, I guess, and being more 301 00:16:39,480 --> 00:16:42,000 Speaker 1: transparent in the long run exactly. 302 00:16:42,200 --> 00:16:44,640 Speaker 3: I think that's what people want. We want to know 303 00:16:44,880 --> 00:16:46,280 Speaker 3: how long we have to wait. We want to know 304 00:16:46,320 --> 00:16:49,480 Speaker 3: who we're waiting in front of them behind and you know, 305 00:16:49,560 --> 00:16:51,440 Speaker 3: and we want to know that there's a process there, 306 00:16:51,480 --> 00:16:54,640 Speaker 3: that there's fairness in the process, because you know, sometimes 307 00:16:54,720 --> 00:16:57,400 Speaker 3: there won't be fairness in the outcome, but you know, 308 00:16:57,480 --> 00:17:00,480 Speaker 3: we can take some faith in that there's fairness equity 309 00:17:00,520 --> 00:17:01,200 Speaker 3: in the process. 310 00:17:01,680 --> 00:17:09,280 Speaker 1: Thanks for joining us, Paula. That's it for this episode 311 00:17:09,320 --> 00:17:12,200 Speaker 1: of The Front Page. You can read more about today's 312 00:17:12,200 --> 00:17:15,800 Speaker 1: stories and extensive news coverage at enzed Herald dot co 313 00:17:16,040 --> 00:17:19,640 Speaker 1: dot nz. The Front Page is produced by Ethan Siles 314 00:17:19,720 --> 00:17:24,560 Speaker 1: with sound engineer Patty Fox. I'm Chelsea Daniels. Subscribe to 315 00:17:24,600 --> 00:17:27,880 Speaker 1: the Front Page on iHeartRadio or wherever you get your podcasts, 316 00:17:28,200 --> 00:17:31,560 Speaker 1: and tune in tomorrow for another look behind the headlines.