Dompost Editorial on Pharmac

The Dompost editorial considers Pharmac:

The Government is right to give Pharmac a funding boost. The state drug-buyer has been squeezed in recent years. It faces new cost pressures, including those coming from the Trans-Pacific Partnership trade deal. Most importantly, it is starting to grapple with a flood of exciting but costly new drugs, notably for cancer.

So it needs more money and it will get an extra $39 million a year. Some of that seems destined to go on a promising drug that treats advanced melanoma, whose sufferers have previously had no publicly-funded drugs available to them.

Over the past year, they ran a powerful campaign arguing for such a medicine, after Pharmac judged one drug, Keytruda, a “low priority” for funding. They will understandably be delighted at the news.

All feeling people will be pleased for them too. But New Zealanders should also be wary about exactly how this decision was made. Was it made purely on the evidence, and by comparing the drug’s costs and merits with all the others competing for Pharmac funding ? or was it a capitulation to public pressure?

We should fervently hope it was the former. The new melanoma drugs are undoubtedly promising, but there have been concerns over a lack of evidence of their long-term effectiveness.

Pharmac is best placed to make decisions on funding, not Labour politicians who have been entertaining executives from the manufacturer of Keytruda.

Meanwhile, there are many urgent calls on Pharmac’s resources, and some don’t have vocal lobbies. Consider that alongside the melanoma decision, Pharmac also moved to fund new treatments for Hepatitis C, another potentially fatal illness. These drugs are highly effective (with a 90 per cent cure rate), their price is declining rapidly, and they treat a disease that afflicts 50,000 New Zealanders. The case was arguably stronger than the one for the cancer drugs, yet public calls for it were much more muted.

There will always be another Hepatitis C. The point is that there’s a limited medicines budget, and it’s best to let the health professionals ? not the politicians ? decide how to use it. The politicians can settle on Pharmac’s budget, balancing it against all the other demands for public spending, but then they should step back.

Health Minister Jonathan Coleman says that is what has happened here. Pharmac agrees. At the very least, it has cut a better deal: the new melanoma drug is not the much-publicised Keytruda, but Opdivo, made by a competitor, which Pharmac says is available on “significantly more favourable” terms.

Such negotiations are Pharmac’s forte. Partly because New Zealand is a tiny market that does not overly exercise pharmaceutical companies, and partly because of its own bargaining nous, Pharmac has had great success in reducing the cost of drugs here. This is a boon for Kiwis, and politicians put it at risk when they meddle too much with the formula.

Politicians should not politicise Pharmac, it is Labour’s shame that they have, and coincidentally after they enjoyed a swanky dinner with Big Pharma executives.

The new funding is hardly the end of the dilemma. Other cutting-edge drugs will emerge and pose the same questions, especially before they are well-proven. Drug companies will keep applying pressure behind the scenes, and there will be more desperate patients seeking expensive drugs.

Without some implausible increase in revenue, or cuts elsewhere, New Zealand won’t be able to pay for them all. It needs to let the medical experts decide what gets funded first.

The Media party has a lot to answer for as well, pimping the sick rolled out by the drug companies to tout for funding?for their drugs. The problem is that there are limited funds and every choice made to fund something by necessity also means others will be un-funded.


– Dom Post