Speaker 1: Kiota. I'm Chelsea Daniels and this is the Front Page,
Speaker 1: a daily podcast presented by the New Zealand Herald. It
Speaker 1: may have taken a month to get there, but the
Speaker 1: government has fulfilled its promise to fund new cancer drugs.
Speaker 1: Rather than the thirteen promised on the campaign trial, it's
Speaker 1: giving six hundred and four million dollars for fifty four
Speaker 1: new medicines, including twenty six cancer treatments. It's hoped the
Speaker 1: promised cancer drugs will be rolled out within the next
Speaker 1: year and a half, with the first becoming available from October.
Speaker 2: But the back and forth.
Speaker 1: Over national's pre election promise has raised questions about why
Speaker 1: it's so difficult to fund drugs in this country and
Speaker 1: if Farmac is up to the task. Today on the
Speaker 1: Front Page, University of Auckland professor doctor PAULA Lorgelli is
Speaker 1: with us to discuss if our decades old process needs
Speaker 1: a refresh. First off, Paul, can you explain to us
Speaker 1: how the FARMAC model works.
Speaker 3: So it is a process where a pharmaceutical company, but
Speaker 3: it doesn't have to be a pharmaceutical company. It can
Speaker 3: be somebody who sponsors a submission to them and says hey,
Speaker 3: we've got this new technology, we think it should be
Speaker 3: publicly funded, and therefore it comes in with a dossier
Speaker 3: of evidence, and you look at the evidence and you say, well,
Speaker 3: how good is it. Medsafe has already decided it's safe
Speaker 3: to use, and so it says, well, is it better
Speaker 3: than what we already have? And then most things generally
Speaker 3: are better than what we already have, And then it says,
Speaker 3: does it generate more given how much it's going to
Speaker 3: cost us? So obviously also things are more expensive, and
Speaker 3: so they kind of assess value for money by looking
Speaker 3: at the benefits of the intervention over a comparator, you
Speaker 3: know what's currently standard practice, and compare that to how
Speaker 3: much it's going to cost to deliver that new technology
Speaker 3: into the health gaess. If they've got budget, then they
Speaker 3: can fund it. They then consult on it and they
Speaker 3: start price negotiating, and then it's listed available for doctors
Speaker 3: and other prescribers to start prescribing those technologies, those pharmaceuticals.
Speaker 3: If they don't have enough budget, then they might try
Speaker 3: to renegotiate some stuff they already have in their kind
Speaker 3: of shopping basket and trying to get more value of
Speaker 3: what they're already funding, so they can try and fund
Speaker 3: something new. If they can't do that, then they put
Speaker 3: it on something they call it options for investment lists,
Speaker 3: which is kind of like their wish list, and then
Speaker 3: when they do come across more funding because they've been
Speaker 3: able to negotiate a better price elsewhere in the system,
Speaker 3: then they can fund what's on their options for investment lists.
Speaker 3: So it's a really universal way of assessing whether what
Speaker 3: you're purchasing gives the public, herve the taxpayers value for money.
Speaker 1: FIMAC was established in nineteen ninety three. Hey, is this
Speaker 1: the best way of funding medicines? Do you think or
Speaker 1: do you think it's time to rethink the model.
Speaker 3: It's our way of funding medicine. So we're kind of
Speaker 3: unique globally, and that FARMAC has a budget, a fixed budget,
Speaker 3: so if you want to fund a drug, you need
Speaker 3: to be able to pay for it. In other countries
Speaker 3: they have the same evidence based assessment, but for example,
Speaker 3: in the UK, or in England and Wales at least,
Speaker 3: and in Australia for example, they actually will say, oh,
Speaker 3: that delivers value for money and then they'll just pass
Speaker 3: on that cost to the rest of the health system
Speaker 3: so they get funded. So other countries don't have this
Speaker 3: waiting list, and I think it's this waiting list that
Speaker 3: most people take issue with, both in New Zealand and
Speaker 3: many other countries. They legitimate and they can say no.
Speaker 3: So if something is way too expensive and it doesn't
Speaker 3: deliver benefit, then they'd say no. There's a whole bunch
Speaker 3: of ways within that process. You could do a different
Speaker 3: job credibly. Whether that's a better job, I'm not sure.
Speaker 3: And you could look at different things that are valuable.
Speaker 3: So you know, how do we as a country value equity?
Speaker 3: So at the moment, we often just look at efficiency.
Speaker 3: Does it deliver value for money? Maybe we want to
Speaker 3: look at how we distribute that benefit around individuals in
Speaker 3: New Zealand and so we might want to look at equity.
Speaker 3: There might be some other things that we value that
Speaker 3: might come into that kind of value proposition. So there
Speaker 3: are different ways of doing it and they probably are better,
Speaker 3: and it just kind of depends on what you think
Speaker 3: is better and what you think is worth doing. I
Speaker 3: think getting rid of a farmac model and having no
Speaker 3: one to assess value is just a disaster wanting to
Speaker 3: happen because it wouldn't mean we would have no ability
Speaker 3: to price negotiate, because we wouldn't have any evidence to
Speaker 3: price negotiate on.
Speaker 1: We've heard the government's funding up to twenty six new
Speaker 1: cancer treatments alongside twenty eight other medicines as part of
Speaker 1: a six hundred and four million dollar health budget to
Speaker 1: honor a national re election promise.
Speaker 4: Clarrent farm ac estimates so that around twenty six cancer
Speaker 4: treatments in twenty eight other treatments will be funded as
Speaker 4: a result of the bold new package that we're announcing today.
Speaker 4: This will be a mix of new medicines and widened
Speaker 4: access to medicines that are already available. Of the thirteen
Speaker 4: cancer treatments listed in twenty twenty three, up to seven
Speaker 4: will now be included, and remaining treatments will be replaced
Speaker 4: by alternatives just as good or better. This means treatments
Speaker 4: for all the cancer types in the pre election manifesto
Speaker 4: list are covered.
Speaker 1: Should parties really be promising funding for drugs when farmac
Speaker 1: is actually meant to be independent anyway? A flat no.
Speaker 3: They can promise funding more drugs, so they could have
Speaker 3: promised a greater FARMAC budget, but they should never go
Speaker 3: and promise specific drugs or even you know, fund in
Speaker 3: a specific area like cancer, because that's the political undermining
Speaker 3: of the independence is FARMAC. And as soon as you've
Speaker 3: indicated that you want to fund a drug, then that
Speaker 3: company now knows that FARMAC won't be hard price negotiating
Speaker 3: with them, right because they're already showing their hand that
Speaker 3: they want to buy that drug. They'll have to buy
Speaker 3: that drug. Why price negotiate hard? I often use the
Speaker 3: analogy It's like kind of like if you want to
Speaker 3: buy a used car, we already know we want to
Speaker 3: buy it, but we're not going to tell the used
Speaker 3: car salesperson you know what we want to pay for
Speaker 3: it straight up, right, we're going to start negotiating. You
Speaker 3: don't show your hand in that situation. And what the
Speaker 3: government did is it showed its hand and it left
Speaker 3: farmc and that really precarious situation, and the only persons
Speaker 3: to benefit was going to be a pharmaceutical industry and
Speaker 3: obviously patients as well, but at the expense of other
Speaker 3: patients who wouldn't be able to access drugs.
Speaker 1: It almost feels like these other drugs only got funded
Speaker 1: because of these cancer drugs were causing a headache for
Speaker 1: the government. In total, we're getting fifty four new medicines
Speaker 1: available for a raft of situations, including those twenty six
Speaker 1: new cancer treatments. We've also we've seen media campaigns in
Speaker 1: the past push for specific drugs to get funded. Is
Speaker 1: there a worry that whatever gets the most media attention,
Speaker 1: I guess can potentially jump that queue in farmac's wait list.
Speaker 3: No, and that's the beauty of FARMAC being independent. It
Speaker 3: should be independent of anybody's own agenda. And I think
Speaker 3: it's really interesting because we are getting up to the
Speaker 3: key there is up to fifty four new medicines coming
Speaker 3: on to the FARMAC list. That would suggest that one
Speaker 3: of those cancer treatments that they wanted to fund must
Speaker 3: have been a long way down that waiting list and
Speaker 3: it hasn't been bumped up, So it's not just that
Speaker 3: they're given them more money. It sounds to me we
Speaker 3: can't see.
Speaker 1: The list right.
Speaker 3: The list is confidential to FARMAC, but given they're having
Speaker 3: to provide money for fifty four up to fifty four drugs,
Speaker 3: of which only twenty six are for cancer, it would
Speaker 3: suggest that some of those newly funded cancer drug were
Speaker 3: lower on that list. Which would suggest that they were
Speaker 3: given the priority that people thought they should have been given.
Speaker 3: But it was an order that was based on priority
Speaker 3: that farmac's advisory groups decide.
Speaker 1: A review into FARMAC a couple of years ago made
Speaker 1: thirty three recommendations with a focus on the agency's governance
Speaker 1: and accountability, its decision making, and a call there for
Speaker 1: a closer look at cancer medicines and rare disorders.
Speaker 2: The interim report into FARMAC condemns the agency, saying it
Speaker 2: has a fortress mentality that permits little transparency, it's not
Speaker 2: fast enough, saying it appears each funding decision takes as
Speaker 2: long as it takes, it's increasingly disconnected from other parts
Speaker 2: of the health system, and farmac's processes are not patient centered.
Speaker 1: In your opinion, has farmac's decision making processes improved since
Speaker 1: that review, I think it was a couple of years ago.
Speaker 5: No.
Speaker 3: I think it's kind of like trying to turn the
Speaker 3: Titanics a slow moving agency. One of the calls was
Speaker 3: for greater transparency. With this impending announcement and now the
Speaker 3: announcement yesterday, I have been looking into what evidence they
Speaker 3: do produce. It's very scant on evidence compared to what
Speaker 3: you might see in other countries. You know, I've analyzed
Speaker 3: submissions and decisions in other countries, so they're not very transparent.
Speaker 3: I'm not aware that their methods have changed. I know
Speaker 3: their methods are under review for undertaking economic evaluations. So
Speaker 3: I think it's been highlighted that there is a need
Speaker 3: for change, and they're well aware of it. But let's
Speaker 3: suspect what's happening within FARMAC is they're spending their day
Speaker 3: job trying to review medicines and they don't have enough
Speaker 3: kind of airtime headspace to actually think about how do
Speaker 3: we change the way that we review medicines, how do
Speaker 3: we change the way we make decisions. So I would
Speaker 3: hope that in some of this new funding they've received
Speaker 3: give some a little bit of space in which to
Speaker 3: change the way they operate.
Speaker 1: I mean, we constantly hear about New Zealanders looking abroad
Speaker 1: for treatments and fundraising for the treatments they need. What
Speaker 1: are these other countries doing differently? Is it a question
Speaker 1: of the money or is it a question of they're
Speaker 1: just quicker at approving new and up to date medical treatments.
Speaker 3: Yeah, some countries have a fast track process where they
Speaker 3: might say, well, we'll approve this medicine even though we're
Speaker 3: a bit unsure about whether it's effective, and then while
Speaker 3: patients are using it, will assess and evaluate how good
Speaker 3: the medicine is. So it's kind of like extending the
Speaker 3: clinical trial evidence into the real world and therefore patients
Speaker 3: get access and then at the end of that period
Speaker 3: they then use that evidence they've collected as part of
Speaker 3: an new evidence review. So there are different ways there
Speaker 3: where you can kind of fast track access, which works
Speaker 3: as long as you've got then an opportunity to renegotiate
Speaker 3: and revisit the price according to how well they worked
Speaker 3: in the real world. So that's an option that happens
Speaker 3: in other countries that we don't have here in New Zealand.
Speaker 1: Because it does feel like New Zealand is constantly on
Speaker 1: the back foot when it comes to these breakthrough drugs
Speaker 1: available overseas. Does it take too long for drugs to
Speaker 1: be approved in New Zealand or do you think it's
Speaker 1: good to be cautious And I.
Speaker 3: Guess it depends on what's approved. I mean it doesn't.
Speaker 3: They are rigorous and it's important that the evidence is
Speaker 3: addressed with an our Chiro and New Zealand lens because
Speaker 3: our healthcare system is different. What they will be displacing
Speaker 3: the system will be different, so we do need to
Speaker 3: have our own evidence dossier. So there's always a longer
Speaker 3: time doing the evaluation, doing the assessment. That's probably longer
Speaker 3: than other countries, but it's just that the budget is
Speaker 3: not available in FARMAC. So in other countries they'll make
Speaker 3: a decision. In England, the National Institute for health Care
Speaker 3: Excellence makes a decision, so NICE makes a decision, and
Speaker 3: then the NHS funds the decision, so the decision has
Speaker 3: just passed on to somebody else with funding, and then
Speaker 3: the NHS has to find funding. It's not that they
Speaker 3: get more money, so they just have to find it
Speaker 3: in another part of their healthcare system. But we just
Speaker 3: don't have that here, and so the constraint for FARMAC
Speaker 3: is that it's constrained by its budgets, so I think
Speaker 3: it probably makes decisions a little bit slower. But then
Speaker 3: pharmaceuticals then go on this waiting list.
Speaker 1: Ozzie murdered. It was the first medication on their list
Speaker 1: that they promised to fund if they were elected into.
Speaker 5: Government, and that's the medication that I desperately need. I've
Speaker 5: spoken to a former health minister and they say National
Speaker 5: should never have promised this in the first place, because essentially,
Speaker 5: when you name thirteen drugs, it shows your hand and
Speaker 5: allows drug companies to milk it.
Speaker 1: Going back to talking about showing our hand, do you
Speaker 1: think National promising these cancer drugs and then the backlash
Speaker 1: of them not actually being included in the budget has
Speaker 1: ultimately cost us money?
Speaker 3: Well, we're only going to fund something we've already evaluated.
Speaker 3: So I'm not clear now on where the industry won't
Speaker 3: budge on price because we've already declared we were going
Speaker 3: to fund them. So it may be costing us more
Speaker 3: than if they had instead just given Farmac the money
Speaker 3: and not named any drugs. So I suspect we will
Speaker 3: be paying more because they outwardly said we wanted to
Speaker 3: fund thirteen cancer drugs.
Speaker 1: So Bill, what ultimately needs to change? Do governments need
Speaker 1: to put more money into drugs just full stop? Does
Speaker 1: Farmac need a refresh? Is it just both elements? Is
Speaker 1: it something else? How do we stop ourselves from having
Speaker 1: these conversations? I guess every few months, Yeah.
Speaker 3: And we'll continue to have these conversations. See some patient
Speaker 3: advocates have come out and said, you know, we hope
Speaker 3: to not have these conversations again, but we will continue
Speaker 3: to see them because of the fixed budget model of FARMAC.
Speaker 3: So if FARMAC didn't have a fixed budget model, then
Speaker 3: we'd be having potentially lease of these conversations, but we'd
Speaker 3: still then have to have broader conversations about value for
Speaker 3: money and the wider healthcare system. I actually think we
Speaker 3: spend a lot of time talking about a part of
Speaker 3: a healthcare system where which actually spend a small percentage
Speaker 3: of our healthcare budget on It just happens to be
Speaker 3: look large in terms of numbers, but I'm going to
Speaker 3: say it's probably something like ten to fifteen percent, which
Speaker 3: is what it is in many other countries. So I
Speaker 3: actually think we probably need to do a better job
Speaker 3: of understanding how do we spending our money our other
Speaker 3: kind of like eighty five percent in the healthcare system.
Speaker 3: So if we had better access to GPS, maybe we'd
Speaker 3: be more proactive and have more preventative healthcare and we
Speaker 3: wouldn't need people having to go on and have many
Speaker 3: of these high cost drugs. So actually, I think a
Speaker 3: broader conversation about how much do we spend on health
Speaker 3: and are we spending it in the right place. So
Speaker 3: FARMAC is an easy one because there's lots of evidence
Speaker 3: around pharmaceuticals and technologies. But maybe we need to have
Speaker 3: a broader conversation about whether there's evidence around more preventive healthcare,
Speaker 3: the scans we get or the surgeries we get, or
Speaker 3: the access we have to GPS. And I think actually
Speaker 3: having a broader kind of healthcare conversation would mean we
Speaker 3: can probably potentially stop focusing on the ambulance at the
Speaker 3: bottom of the cliff, which is a lot of these drugs,
Speaker 3: and think more about having a healthier healthcare system.
Speaker 1: So, just to confirm Paula, you reckon that FARMAC shouldn't
Speaker 1: have its own independent funding. I guess it should be
Speaker 1: an approval process and then go through the health budget
Speaker 1: like other countries.
Speaker 3: I'm not sure I'm recommending that. Yeah, that would require
Speaker 3: some other things for FARMAC to change that we'd have
Speaker 3: to understand what our threshold would be in terms of
Speaker 3: cost effectness, so that it would require a few steps
Speaker 3: before I went down that recommendation approach. And I'm also
Speaker 3: not sure that that's necessarily any better or worse. Because
Speaker 3: FARMAC does have a fixed budget, it does negotiate very well.
Speaker 3: So the fact that people say, oh, we paid some
Speaker 3: of the least for drugs, I think we should be
Speaker 3: proud of that because that's because FARMAC is doing its
Speaker 3: job so well. If we took away potentially that fixed budget,
Speaker 3: so FARMAC just was passing the costs onto another part
Speaker 3: of the healthcare system, maybe FARMAC wouldn't be so strong
Speaker 3: in a negotiating stance. So it's kind of like, you know,
Speaker 3: where's the balance there.
Speaker 1: So just finding that balance, I guess, and being more
Speaker 1: transparent in the long run exactly.
Speaker 3: I think that's what people want. We want to know
Speaker 3: how long we have to wait. We want to know
Speaker 3: who we're waiting in front of them behind and you know,
Speaker 3: and we want to know that there's a process there,
Speaker 3: that there's fairness in the process, because you know, sometimes
Speaker 3: there won't be fairness in the outcome, but you know,
Speaker 3: we can take some faith in that there's fairness equity
Speaker 3: in the process.
Speaker 1: Thanks for joining us, Paula. That's it for this episode
Speaker 1: of The Front Page. You can read more about today's
Speaker 1: stories and extensive news coverage at enzed Herald dot co
Speaker 1: dot nz. The Front Page is produced by Ethan Siles
Speaker 1: with sound engineer Patty Fox. I'm Chelsea Daniels. Subscribe to
Speaker 1: the Front Page on iHeartRadio or wherever you get your podcasts,
Speaker 1: and tune in tomorrow for another look behind the headlines.