June 25, 2024 • 17 mins
It may have taken a month to get there, but the Government has fulfilled its promise to fund new cancer drugs.
Rather than the 13 promised on the campaign trail, it's giving $604 million for 54 new medicines, including 26 cancer treatments.
It's hoped the promised cancer drugs will be rolled out within the next year and a half – with the first becoming available from October.
But the back and forth over National’s pre-election promise has raised questions about why it’s so difficult to fund drugs in this country – and if Pharmac is up to the task.
Today on The Front Page, University of Auckland Professor Dr Paula Lorgelly joins us to discuss if our decades-old process needs a refresh.
Follow The Front Page on iHeartRadio, Apple Podcasts, Spotify or wherever you get your podcasts.
You can read more about this and other stories in the New Zealand Herald, online at nzherald.co.nz, or tune in to news bulletins across the NZME network.
Host: Chelsea Daniels
Sound Engineer: Paddy Fox
Producer: Ethan Sills
See omnystudio.com/listener for privacy information.
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:05):
Kiota. I'm Chelsea Daniels and this is the Front Page,
a daily podcast presented by the New Zealand Herald. It
may have taken a month to get there, but the
government has fulfilled its promise to fund new cancer drugs.
Rather than the thirteen promised on the campaign trial, it's
(00:27):
giving six hundred and four million dollars for fifty four
new medicines, including twenty six cancer treatments. It's hoped the
promised cancer drugs will be rolled out within the next
year and a half, with the first becoming available from October.
Speaker 2 (00:44):
But the back and forth.
Speaker 1 (00:45):
Over national's pre election promise has raised questions about why
it's so difficult to fund drugs in this country and
if Farmac is up to the task. Today on the
Front Page, University of Auckland professor doctor PAULA Lorgelli is
with us to discuss if our decades old process needs
a refresh. First off, Paul, can you explain to us
(01:07):
how the FARMAC model works.
Speaker 3 (01:10):
So it is a process where a pharmaceutical company, but
it doesn't have to be a pharmaceutical company. It can
be somebody who sponsors a submission to them and says hey,
we've got this new technology, we think it should be
publicly funded, and therefore it comes in with a dossier
of evidence, and you look at the evidence and you say, well,
how good is it. Medsafe has already decided it's safe
(01:32):
to use, and so it says, well, is it better
than what we already have? And then most things generally
are better than what we already have, And then it says,
does it generate more given how much it's going to
cost us? So obviously also things are more expensive, and
so they kind of assess value for money by looking
at the benefits of the intervention over a comparator, you
(01:52):
know what's currently standard practice, and compare that to how
much it's going to cost to deliver that new technology
into the health gaess. If they've got budget, then they
can fund it. They then consult on it and they
start price negotiating, and then it's listed available for doctors
and other prescribers to start prescribing those technologies, those pharmaceuticals.
(02:17):
If they don't have enough budget, then they might try
to renegotiate some stuff they already have in their kind
of shopping basket and trying to get more value of
what they're already funding, so they can try and fund
something new. If they can't do that, then they put
it on something they call it options for investment lists,
which is kind of like their wish list, and then
when they do come across more funding because they've been
(02:39):
able to negotiate a better price elsewhere in the system,
then they can fund what's on their options for investment lists.
So it's a really universal way of assessing whether what
you're purchasing gives the public, herve the taxpayers value for money.
Speaker 1 (02:55):
FIMAC was established in nineteen ninety three. Hey, is this
the best way of funding medicines? Do you think or
do you think it's time to rethink the model.
Speaker 3 (03:04):
It's our way of funding medicine. So we're kind of
unique globally, and that FARMAC has a budget, a fixed budget,
so if you want to fund a drug, you need
to be able to pay for it. In other countries
they have the same evidence based assessment, but for example,
in the UK, or in England and Wales at least,
(03:25):
and in Australia for example, they actually will say, oh,
that delivers value for money and then they'll just pass
on that cost to the rest of the health system
so they get funded. So other countries don't have this
waiting list, and I think it's this waiting list that
most people take issue with, both in New Zealand and
many other countries. They legitimate and they can say no.
So if something is way too expensive and it doesn't
(03:46):
deliver benefit, then they'd say no. There's a whole bunch
of ways within that process. You could do a different
job credibly. Whether that's a better job, I'm not sure.
And you could look at different things that are valuable.
So you know, how do we as a country value equity?
So at the moment, we often just look at efficiency.
(04:08):
Does it deliver value for money? Maybe we want to
look at how we distribute that benefit around individuals in
New Zealand and so we might want to look at equity.
There might be some other things that we value that
might come into that kind of value proposition. So there
are different ways of doing it and they probably are better,
and it just kind of depends on what you think
(04:31):
is better and what you think is worth doing. I
think getting rid of a farmac model and having no
one to assess value is just a disaster wanting to
happen because it wouldn't mean we would have no ability
to price negotiate, because we wouldn't have any evidence to
price negotiate on.
Speaker 1 (04:48):
We've heard the government's funding up to twenty six new
cancer treatments alongside twenty eight other medicines as part of
a six hundred and four million dollar health budget to
honor a national re election promise.
Speaker 4 (05:02):
Clarrent farm ac estimates so that around twenty six cancer
treatments in twenty eight other treatments will be funded as
a result of the bold new package that we're announcing today.
This will be a mix of new medicines and widened
access to medicines that are already available. Of the thirteen
cancer treatments listed in twenty twenty three, up to seven
will now be included, and remaining treatments will be replaced
by alternatives just as good or better. This means treatments
(05:24):
for all the cancer types in the pre election manifesto
list are covered.
Speaker 1 (05:30):
Should parties really be promising funding for drugs when farmac
is actually meant to be independent anyway? A flat no.
Speaker 3 (05:38):
They can promise funding more drugs, so they could have
promised a greater FARMAC budget, but they should never go
and promise specific drugs or even you know, fund in
a specific area like cancer, because that's the political undermining
of the independence is FARMAC. And as soon as you've
(05:59):
indicated that you want to fund a drug, then that
company now knows that FARMAC won't be hard price negotiating
with them, right because they're already showing their hand that
they want to buy that drug. They'll have to buy
that drug. Why price negotiate hard? I often use the
analogy It's like kind of like if you want to
buy a used car, we already know we want to
buy it, but we're not going to tell the used
(06:19):
car salesperson you know what we want to pay for
it straight up, right, we're going to start negotiating. You
don't show your hand in that situation. And what the
government did is it showed its hand and it left
farmc and that really precarious situation, and the only persons
to benefit was going to be a pharmaceutical industry and
obviously patients as well, but at the expense of other
(06:41):
patients who wouldn't be able to access drugs.
Speaker 1 (06:44):
It almost feels like these other drugs only got funded
because of these cancer drugs were causing a headache for
the government. In total, we're getting fifty four new medicines
available for a raft of situations, including those twenty six
new cancer treatments. We've also we've seen media campaigns in
the past push for specific drugs to get funded. Is
(07:05):
there a worry that whatever gets the most media attention,
I guess can potentially jump that queue in farmac's wait list.
Speaker 3 (07:13):
No, and that's the beauty of FARMAC being independent. It
should be independent of anybody's own agenda. And I think
it's really interesting because we are getting up to the
key there is up to fifty four new medicines coming
on to the FARMAC list. That would suggest that one
of those cancer treatments that they wanted to fund must
(07:37):
have been a long way down that waiting list and
it hasn't been bumped up, So it's not just that
they're given them more money. It sounds to me we
can't see.
Speaker 1 (07:45):
The list right.
Speaker 3 (07:46):
The list is confidential to FARMAC, but given they're having
to provide money for fifty four up to fifty four drugs,
of which only twenty six are for cancer, it would
suggest that some of those newly funded cancer drug were
lower on that list. Which would suggest that they were
given the priority that people thought they should have been given.
(08:07):
But it was an order that was based on priority
that farmac's advisory groups decide.
Speaker 1 (08:13):
A review into FARMAC a couple of years ago made
thirty three recommendations with a focus on the agency's governance
and accountability, its decision making, and a call there for
a closer look at cancer medicines and rare disorders.
Speaker 2 (08:31):
The interim report into FARMAC condemns the agency, saying it
has a fortress mentality that permits little transparency, it's not
fast enough, saying it appears each funding decision takes as
long as it takes, it's increasingly disconnected from other parts
of the health system, and farmac's processes are not patient centered.
Speaker 1 (08:53):
In your opinion, has farmac's decision making processes improved since
that review, I think it was a couple of years ago.
Speaker 5 (09:00):
No.
Speaker 3 (09:01):
I think it's kind of like trying to turn the
Titanics a slow moving agency. One of the calls was
for greater transparency. With this impending announcement and now the
announcement yesterday, I have been looking into what evidence they
do produce. It's very scant on evidence compared to what
you might see in other countries. You know, I've analyzed
submissions and decisions in other countries, so they're not very transparent.
(09:24):
I'm not aware that their methods have changed. I know
their methods are under review for undertaking economic evaluations. So
I think it's been highlighted that there is a need
for change, and they're well aware of it. But let's
suspect what's happening within FARMAC is they're spending their day
job trying to review medicines and they don't have enough
(09:46):
kind of airtime headspace to actually think about how do
we change the way that we review medicines, how do
we change the way we make decisions. So I would
hope that in some of this new funding they've received
give some a little bit of space in which to
change the way they operate.
Speaker 1 (10:13):
I mean, we constantly hear about New Zealanders looking abroad
for treatments and fundraising for the treatments they need. What
are these other countries doing differently? Is it a question
of the money or is it a question of they're
just quicker at approving new and up to date medical treatments.
Speaker 3 (10:31):
Yeah, some countries have a fast track process where they
might say, well, we'll approve this medicine even though we're
a bit unsure about whether it's effective, and then while
patients are using it, will assess and evaluate how good
the medicine is. So it's kind of like extending the
clinical trial evidence into the real world and therefore patients
(10:53):
get access and then at the end of that period
they then use that evidence they've collected as part of
an new evidence review. So there are different ways there
where you can kind of fast track access, which works
as long as you've got then an opportunity to renegotiate
and revisit the price according to how well they worked
in the real world. So that's an option that happens
(11:16):
in other countries that we don't have here in New Zealand.
Speaker 1 (11:18):
Because it does feel like New Zealand is constantly on
the back foot when it comes to these breakthrough drugs
available overseas. Does it take too long for drugs to
be approved in New Zealand or do you think it's
good to be cautious And I.
Speaker 3 (11:31):
Guess it depends on what's approved. I mean it doesn't.
They are rigorous and it's important that the evidence is
addressed with an our Chiro and New Zealand lens because
our healthcare system is different. What they will be displacing
the system will be different, so we do need to
have our own evidence dossier. So there's always a longer
time doing the evaluation, doing the assessment. That's probably longer
(11:53):
than other countries, but it's just that the budget is
not available in FARMAC. So in other countries they'll make
a decision. In England, the National Institute for health Care
Excellence makes a decision, so NICE makes a decision, and
then the NHS funds the decision, so the decision has
just passed on to somebody else with funding, and then
(12:14):
the NHS has to find funding. It's not that they
get more money, so they just have to find it
in another part of their healthcare system. But we just
don't have that here, and so the constraint for FARMAC
is that it's constrained by its budgets, so I think
it probably makes decisions a little bit slower. But then
pharmaceuticals then go on this waiting list.
Speaker 1 (12:33):
Ozzie murdered. It was the first medication on their list
that they promised to fund if they were elected into.
Speaker 5 (12:40):
Government, and that's the medication that I desperately need. I've
spoken to a former health minister and they say National
should never have promised this in the first place, because essentially,
when you name thirteen drugs, it shows your hand and
allows drug companies to milk it.
Speaker 1 (12:56):
Going back to talking about showing our hand, do you
think National promising these cancer drugs and then the backlash
of them not actually being included in the budget has
ultimately cost us money?
Speaker 3 (13:09):
Well, we're only going to fund something we've already evaluated.
So I'm not clear now on where the industry won't
budge on price because we've already declared we were going
to fund them. So it may be costing us more
than if they had instead just given Farmac the money
(13:29):
and not named any drugs. So I suspect we will
be paying more because they outwardly said we wanted to
fund thirteen cancer drugs.
Speaker 1 (13:38):
So Bill, what ultimately needs to change? Do governments need
to put more money into drugs just full stop? Does
Farmac need a refresh? Is it just both elements? Is
it something else? How do we stop ourselves from having
these conversations? I guess every few months, Yeah.
Speaker 3 (13:55):
And we'll continue to have these conversations. See some patient
advocates have come out and said, you know, we hope
to not have these conversations again, but we will continue
to see them because of the fixed budget model of FARMAC.
So if FARMAC didn't have a fixed budget model, then
we'd be having potentially lease of these conversations, but we'd
still then have to have broader conversations about value for
(14:17):
money and the wider healthcare system. I actually think we
spend a lot of time talking about a part of
a healthcare system where which actually spend a small percentage
of our healthcare budget on It just happens to be
look large in terms of numbers, but I'm going to
say it's probably something like ten to fifteen percent, which
is what it is in many other countries. So I
(14:39):
actually think we probably need to do a better job
of understanding how do we spending our money our other
kind of like eighty five percent in the healthcare system.
So if we had better access to GPS, maybe we'd
be more proactive and have more preventative healthcare and we
wouldn't need people having to go on and have many
of these high cost drugs. So actually, I think a
(15:00):
broader conversation about how much do we spend on health
and are we spending it in the right place. So
FARMAC is an easy one because there's lots of evidence
around pharmaceuticals and technologies. But maybe we need to have
a broader conversation about whether there's evidence around more preventive healthcare,
the scans we get or the surgeries we get, or
(15:23):
the access we have to GPS. And I think actually
having a broader kind of healthcare conversation would mean we
can probably potentially stop focusing on the ambulance at the
bottom of the cliff, which is a lot of these drugs,
and think more about having a healthier healthcare system.
Speaker 1 (15:40):
So, just to confirm Paula, you reckon that FARMAC shouldn't
have its own independent funding. I guess it should be
an approval process and then go through the health budget
like other countries.
Speaker 3 (15:52):
I'm not sure I'm recommending that. Yeah, that would require
some other things for FARMAC to change that we'd have
to understand what our threshold would be in terms of
cost effectness, so that it would require a few steps
before I went down that recommendation approach. And I'm also
not sure that that's necessarily any better or worse. Because
FARMAC does have a fixed budget, it does negotiate very well.
(16:13):
So the fact that people say, oh, we paid some
of the least for drugs, I think we should be
proud of that because that's because FARMAC is doing its
job so well. If we took away potentially that fixed budget,
so FARMAC just was passing the costs onto another part
of the healthcare system, maybe FARMAC wouldn't be so strong
in a negotiating stance. So it's kind of like, you know,
(16:35):
where's the balance there.
Speaker 1 (16:36):
So just finding that balance, I guess, and being more
transparent in the long run exactly.
Speaker 3 (16:42):
I think that's what people want. We want to know
how long we have to wait. We want to know
who we're waiting in front of them behind and you know,
and we want to know that there's a process there,
that there's fairness in the process, because you know, sometimes
there won't be fairness in the outcome, but you know,
we can take some faith in that there's fairness equity
in the process.
Speaker 1 (17:01):
Thanks for joining us, Paula. That's it for this episode
of The Front Page. You can read more about today's
stories and extensive news coverage at enzed Herald dot co
dot nz. The Front Page is produced by Ethan Siles
with sound engineer Patty Fox. I'm Chelsea Daniels. Subscribe to
(17:24):
the Front Page on iHeartRadio or wherever you get your podcasts,
and tune in tomorrow for another look behind the headlines.
Kiota. I'm Chelsea Daniels and this is the Front Page,
a daily podcast presented by the New Zealand Herald. It
may have taken a month to get there, but the
government has fulfilled its promise to fund new cancer drugs.
Rather than the thirteen promised on the campaign trial, it's
(00:27):
giving six hundred and four million dollars for fifty four
new medicines, including twenty six cancer treatments. It's hoped the
promised cancer drugs will be rolled out within the next
year and a half, with the first becoming available from October.
Speaker 2 (00:44):
But the back and forth.
Speaker 1 (00:45):
Over national's pre election promise has raised questions about why
it's so difficult to fund drugs in this country and
if Farmac is up to the task. Today on the
Front Page, University of Auckland professor doctor PAULA Lorgelli is
with us to discuss if our decades old process needs
a refresh. First off, Paul, can you explain to us
(01:07):
how the FARMAC model works.
Speaker 3 (01:10):
So it is a process where a pharmaceutical company, but
it doesn't have to be a pharmaceutical company. It can
be somebody who sponsors a submission to them and says hey,
we've got this new technology, we think it should be
publicly funded, and therefore it comes in with a dossier
of evidence, and you look at the evidence and you say, well,
how good is it. Medsafe has already decided it's safe
(01:32):
to use, and so it says, well, is it better
than what we already have? And then most things generally
are better than what we already have, And then it says,
does it generate more given how much it's going to
cost us? So obviously also things are more expensive, and
so they kind of assess value for money by looking
at the benefits of the intervention over a comparator, you
(01:52):
know what's currently standard practice, and compare that to how
much it's going to cost to deliver that new technology
into the health gaess. If they've got budget, then they
can fund it. They then consult on it and they
start price negotiating, and then it's listed available for doctors
and other prescribers to start prescribing those technologies, those pharmaceuticals.
(02:17):
If they don't have enough budget, then they might try
to renegotiate some stuff they already have in their kind
of shopping basket and trying to get more value of
what they're already funding, so they can try and fund
something new. If they can't do that, then they put
it on something they call it options for investment lists,
which is kind of like their wish list, and then
when they do come across more funding because they've been
(02:39):
able to negotiate a better price elsewhere in the system,
then they can fund what's on their options for investment lists.
So it's a really universal way of assessing whether what
you're purchasing gives the public, herve the taxpayers value for money.
Speaker 1 (02:55):
FIMAC was established in nineteen ninety three. Hey, is this
the best way of funding medicines? Do you think or
do you think it's time to rethink the model.
Speaker 3 (03:04):
It's our way of funding medicine. So we're kind of
unique globally, and that FARMAC has a budget, a fixed budget,
so if you want to fund a drug, you need
to be able to pay for it. In other countries
they have the same evidence based assessment, but for example,
in the UK, or in England and Wales at least,
(03:25):
and in Australia for example, they actually will say, oh,
that delivers value for money and then they'll just pass
on that cost to the rest of the health system
so they get funded. So other countries don't have this
waiting list, and I think it's this waiting list that
most people take issue with, both in New Zealand and
many other countries. They legitimate and they can say no.
So if something is way too expensive and it doesn't
(03:46):
deliver benefit, then they'd say no. There's a whole bunch
of ways within that process. You could do a different
job credibly. Whether that's a better job, I'm not sure.
And you could look at different things that are valuable.
So you know, how do we as a country value equity?
So at the moment, we often just look at efficiency.
(04:08):
Does it deliver value for money? Maybe we want to
look at how we distribute that benefit around individuals in
New Zealand and so we might want to look at equity.
There might be some other things that we value that
might come into that kind of value proposition. So there
are different ways of doing it and they probably are better,
and it just kind of depends on what you think
(04:31):
is better and what you think is worth doing. I
think getting rid of a farmac model and having no
one to assess value is just a disaster wanting to
happen because it wouldn't mean we would have no ability
to price negotiate, because we wouldn't have any evidence to
price negotiate on.
Speaker 1 (04:48):
We've heard the government's funding up to twenty six new
cancer treatments alongside twenty eight other medicines as part of
a six hundred and four million dollar health budget to
honor a national re election promise.
Speaker 4 (05:02):
Clarrent farm ac estimates so that around twenty six cancer
treatments in twenty eight other treatments will be funded as
a result of the bold new package that we're announcing today.
This will be a mix of new medicines and widened
access to medicines that are already available. Of the thirteen
cancer treatments listed in twenty twenty three, up to seven
will now be included, and remaining treatments will be replaced
by alternatives just as good or better. This means treatments
(05:24):
for all the cancer types in the pre election manifesto
list are covered.
Speaker 1 (05:30):
Should parties really be promising funding for drugs when farmac
is actually meant to be independent anyway? A flat no.
Speaker 3 (05:38):
They can promise funding more drugs, so they could have
promised a greater FARMAC budget, but they should never go
and promise specific drugs or even you know, fund in
a specific area like cancer, because that's the political undermining
of the independence is FARMAC. And as soon as you've
(05:59):
indicated that you want to fund a drug, then that
company now knows that FARMAC won't be hard price negotiating
with them, right because they're already showing their hand that
they want to buy that drug. They'll have to buy
that drug. Why price negotiate hard? I often use the
analogy It's like kind of like if you want to
buy a used car, we already know we want to
buy it, but we're not going to tell the used
(06:19):
car salesperson you know what we want to pay for
it straight up, right, we're going to start negotiating. You
don't show your hand in that situation. And what the
government did is it showed its hand and it left
farmc and that really precarious situation, and the only persons
to benefit was going to be a pharmaceutical industry and
obviously patients as well, but at the expense of other
(06:41):
patients who wouldn't be able to access drugs.
Speaker 1 (06:44):
It almost feels like these other drugs only got funded
because of these cancer drugs were causing a headache for
the government. In total, we're getting fifty four new medicines
available for a raft of situations, including those twenty six
new cancer treatments. We've also we've seen media campaigns in
the past push for specific drugs to get funded. Is
(07:05):
there a worry that whatever gets the most media attention,
I guess can potentially jump that queue in farmac's wait list.
Speaker 3 (07:13):
No, and that's the beauty of FARMAC being independent. It
should be independent of anybody's own agenda. And I think
it's really interesting because we are getting up to the
key there is up to fifty four new medicines coming
on to the FARMAC list. That would suggest that one
of those cancer treatments that they wanted to fund must
(07:37):
have been a long way down that waiting list and
it hasn't been bumped up, So it's not just that
they're given them more money. It sounds to me we
can't see.
Speaker 1 (07:45):
The list right.
Speaker 3 (07:46):
The list is confidential to FARMAC, but given they're having
to provide money for fifty four up to fifty four drugs,
of which only twenty six are for cancer, it would
suggest that some of those newly funded cancer drug were
lower on that list. Which would suggest that they were
given the priority that people thought they should have been given.
(08:07):
But it was an order that was based on priority
that farmac's advisory groups decide.
Speaker 1 (08:13):
A review into FARMAC a couple of years ago made
thirty three recommendations with a focus on the agency's governance
and accountability, its decision making, and a call there for
a closer look at cancer medicines and rare disorders.
Speaker 2 (08:31):
The interim report into FARMAC condemns the agency, saying it
has a fortress mentality that permits little transparency, it's not
fast enough, saying it appears each funding decision takes as
long as it takes, it's increasingly disconnected from other parts
of the health system, and farmac's processes are not patient centered.
Speaker 1 (08:53):
In your opinion, has farmac's decision making processes improved since
that review, I think it was a couple of years ago.
Speaker 5 (09:00):
No.
Speaker 3 (09:01):
I think it's kind of like trying to turn the
Titanics a slow moving agency. One of the calls was
for greater transparency. With this impending announcement and now the
announcement yesterday, I have been looking into what evidence they
do produce. It's very scant on evidence compared to what
you might see in other countries. You know, I've analyzed
submissions and decisions in other countries, so they're not very transparent.
(09:24):
I'm not aware that their methods have changed. I know
their methods are under review for undertaking economic evaluations. So
I think it's been highlighted that there is a need
for change, and they're well aware of it. But let's
suspect what's happening within FARMAC is they're spending their day
job trying to review medicines and they don't have enough
(09:46):
kind of airtime headspace to actually think about how do
we change the way that we review medicines, how do
we change the way we make decisions. So I would
hope that in some of this new funding they've received
give some a little bit of space in which to
change the way they operate.
Speaker 1 (10:13):
I mean, we constantly hear about New Zealanders looking abroad
for treatments and fundraising for the treatments they need. What
are these other countries doing differently? Is it a question
of the money or is it a question of they're
just quicker at approving new and up to date medical treatments.
Speaker 3 (10:31):
Yeah, some countries have a fast track process where they
might say, well, we'll approve this medicine even though we're
a bit unsure about whether it's effective, and then while
patients are using it, will assess and evaluate how good
the medicine is. So it's kind of like extending the
clinical trial evidence into the real world and therefore patients
(10:53):
get access and then at the end of that period
they then use that evidence they've collected as part of
an new evidence review. So there are different ways there
where you can kind of fast track access, which works
as long as you've got then an opportunity to renegotiate
and revisit the price according to how well they worked
in the real world. So that's an option that happens
(11:16):
in other countries that we don't have here in New Zealand.
Speaker 1 (11:18):
Because it does feel like New Zealand is constantly on
the back foot when it comes to these breakthrough drugs
available overseas. Does it take too long for drugs to
be approved in New Zealand or do you think it's
good to be cautious And I.
Speaker 3 (11:31):
Guess it depends on what's approved. I mean it doesn't.
They are rigorous and it's important that the evidence is
addressed with an our Chiro and New Zealand lens because
our healthcare system is different. What they will be displacing
the system will be different, so we do need to
have our own evidence dossier. So there's always a longer
time doing the evaluation, doing the assessment. That's probably longer
(11:53):
than other countries, but it's just that the budget is
not available in FARMAC. So in other countries they'll make
a decision. In England, the National Institute for health Care
Excellence makes a decision, so NICE makes a decision, and
then the NHS funds the decision, so the decision has
just passed on to somebody else with funding, and then
(12:14):
the NHS has to find funding. It's not that they
get more money, so they just have to find it
in another part of their healthcare system. But we just
don't have that here, and so the constraint for FARMAC
is that it's constrained by its budgets, so I think
it probably makes decisions a little bit slower. But then
pharmaceuticals then go on this waiting list.
Speaker 1 (12:33):
Ozzie murdered. It was the first medication on their list
that they promised to fund if they were elected into.
Speaker 5 (12:40):
Government, and that's the medication that I desperately need. I've
spoken to a former health minister and they say National
should never have promised this in the first place, because essentially,
when you name thirteen drugs, it shows your hand and
allows drug companies to milk it.
Speaker 1 (12:56):
Going back to talking about showing our hand, do you
think National promising these cancer drugs and then the backlash
of them not actually being included in the budget has
ultimately cost us money?
Speaker 3 (13:09):
Well, we're only going to fund something we've already evaluated.
So I'm not clear now on where the industry won't
budge on price because we've already declared we were going
to fund them. So it may be costing us more
than if they had instead just given Farmac the money
(13:29):
and not named any drugs. So I suspect we will
be paying more because they outwardly said we wanted to
fund thirteen cancer drugs.
Speaker 1 (13:38):
So Bill, what ultimately needs to change? Do governments need
to put more money into drugs just full stop? Does
Farmac need a refresh? Is it just both elements? Is
it something else? How do we stop ourselves from having
these conversations? I guess every few months, Yeah.
Speaker 3 (13:55):
And we'll continue to have these conversations. See some patient
advocates have come out and said, you know, we hope
to not have these conversations again, but we will continue
to see them because of the fixed budget model of FARMAC.
So if FARMAC didn't have a fixed budget model, then
we'd be having potentially lease of these conversations, but we'd
still then have to have broader conversations about value for
(14:17):
money and the wider healthcare system. I actually think we
spend a lot of time talking about a part of
a healthcare system where which actually spend a small percentage
of our healthcare budget on It just happens to be
look large in terms of numbers, but I'm going to
say it's probably something like ten to fifteen percent, which
is what it is in many other countries. So I
(14:39):
actually think we probably need to do a better job
of understanding how do we spending our money our other
kind of like eighty five percent in the healthcare system.
So if we had better access to GPS, maybe we'd
be more proactive and have more preventative healthcare and we
wouldn't need people having to go on and have many
of these high cost drugs. So actually, I think a
(15:00):
broader conversation about how much do we spend on health
and are we spending it in the right place. So
FARMAC is an easy one because there's lots of evidence
around pharmaceuticals and technologies. But maybe we need to have
a broader conversation about whether there's evidence around more preventive healthcare,
the scans we get or the surgeries we get, or
(15:23):
the access we have to GPS. And I think actually
having a broader kind of healthcare conversation would mean we
can probably potentially stop focusing on the ambulance at the
bottom of the cliff, which is a lot of these drugs,
and think more about having a healthier healthcare system.
Speaker 1 (15:40):
So, just to confirm Paula, you reckon that FARMAC shouldn't
have its own independent funding. I guess it should be
an approval process and then go through the health budget
like other countries.
Speaker 3 (15:52):
I'm not sure I'm recommending that. Yeah, that would require
some other things for FARMAC to change that we'd have
to understand what our threshold would be in terms of
cost effectness, so that it would require a few steps
before I went down that recommendation approach. And I'm also
not sure that that's necessarily any better or worse. Because
FARMAC does have a fixed budget, it does negotiate very well.
(16:13):
So the fact that people say, oh, we paid some
of the least for drugs, I think we should be
proud of that because that's because FARMAC is doing its
job so well. If we took away potentially that fixed budget,
so FARMAC just was passing the costs onto another part
of the healthcare system, maybe FARMAC wouldn't be so strong
in a negotiating stance. So it's kind of like, you know,
(16:35):
where's the balance there.
Speaker 1 (16:36):
So just finding that balance, I guess, and being more
transparent in the long run exactly.
Speaker 3 (16:42):
I think that's what people want. We want to know
how long we have to wait. We want to know
who we're waiting in front of them behind and you know,
and we want to know that there's a process there,
that there's fairness in the process, because you know, sometimes
there won't be fairness in the outcome, but you know,
we can take some faith in that there's fairness equity
in the process.
Speaker 1 (17:01):
Thanks for joining us, Paula. That's it for this episode
of The Front Page. You can read more about today's
stories and extensive news coverage at enzed Herald dot co
dot nz. The Front Page is produced by Ethan Siles
with sound engineer Patty Fox. I'm Chelsea Daniels. Subscribe to
(17:24):
the Front Page on iHeartRadio or wherever you get your podcasts,
and tune in tomorrow for another look behind the headlines.
Popular Podcasts
Dateline NBC
Current and classic episodes, featuring compelling true-crime mysteries, powerful documentaries and in-depth investigations. Follow now to get the latest episodes of Dateline NBC completely free, or subscribe to Dateline Premium for ad-free listening and exclusive bonus content: DatelinePremium.com
24/7 News: The Latest
The latest news in 4 minutes updated every hour, every day.
Therapy Gecko
An unlicensed lizard psychologist travels the universe talking to strangers about absolutely nothing. TO CALL THE GECKO: follow me on https://www.twitch.tv/lyleforever to get a notification for when I am taking calls. I am usually live Mondays, Wednesdays, and Fridays but lately a lot of other times too. I am a gecko.