Pharmac recently announced $190 million of new funding for medicines. However, only one breast cancer drug made it onto their investment list. Kadcyla (aka trastuzumab emtansine) is currently available in New Zealand only for those with advanced breast cancer. Recent research has shown that it is also useful for women with early HER2 positive breast cancer who have had chemotherapy and targeted therapy (Herceptin = trastuzumab) to shrink their tumours before surgery, but were found to still have some cancer left in the breast or lymph nodes at surgery. Pharmac has just announced it will fund Kadcycla for these patients (about 70 women per year). This treatment will halve the risk of cancer coming back for these women. But there is a catch – if you receive Kadcyla for your early breast cancer, and it later comes back as advanced cancer, you cannot have this medicine again.
‘So Pharmac has given us something with one hand and taken it away with the other’, said Libby Burgess, BCAC Chairperson, who was interviewed on TV One’s Breakfast show.
Libby explained how NZ lags well behind other countries in the provision of breast cancer medicines: ‘The European Society for Medical Oncology (ESMO) recommends 41 medicines for advanced breast cancer; NZ funds only 19 of these (31 are funded in Australia). For early breast cancer, ESMO recommends 15 medicines; Pharmac’s Kadcyla decision adds one more for NZ women, but we’re still missing three of those 15.’
‘This is a typical rationing strategy that we see not only with breast cancer medicines but across all diseases.’
‘Pharmac also does not fund retreatment with trastuzumab (Herceptin) in advanced breast cancer although this is a basic standard of care in other countries. Clinical trials overseas have shown that retreatment in combination with newer medicines can give women longer, healthier lives but we’re excluded from those options. We can’t even participate in clinical trials with breakthrough medicines because we don’t fund this basic treatment.’
‘There are two exciting new medicines that have been shown to be highly effective for this same sub-type of breast cancer (Enhertu = trastuzumab deruxtecan and Tukysa = tucatinib) but we expect to wait years until they’re funded here. There are other great new medicines for different breast cancer subtypes but again, we don’t expect to see those funded here any time soon.’
Libby noted how, in a comparison of 20 OECD countries, New Zealand consistently falls last in access to modern medicines. The few we do fund take twice as long to be made available than in other countries and between 2011 and 2020 Australia publicly funded three times more modern medicines than New Zealand.
‘Our poor access to medicines means if we can afford to pay we’re able to live longer, healthier lives. This has a huge impact on health equity. Fewer Māori and Pasifika people have access to the funds needed to buy modern medicines and fewer have health insurance. Everyone with a low income is in the same boat.’
‘We’ve lived for decades as a country under the Pharmac rationing model. There has been a review of that model and some necessary changes identified, but the medicines budget was never part of that review and it is at the heart of the problem.’
BCAC’s formal response to Pharmac’s consultation on the provision of Kadcyla can be seen here.
29 June 2022
