The Medicine Gap

19/02/2025

Last week, at the New Zealand Economics Forum at the University of Waikato, I joined a panel to discuss 'Pharmac and Medicines: Balancing Politics and Public Health'.

For a number of years, I've documented the complexities and failures of the Pharmac model through The Medicine Gap, highlighting the impact on the lives of New Zealanders, our health system, and the wider economy.

This time, it was different. I was given an opportunity to talk about how we might reform the model. The link to the 60minute conversation is in the comments, but here's an Executive Summary.

* Invest more in medicines. Yes, we've significantly increased the budget, but we've underinvested in medicines and medical technologies for over 12 years. More than 100 medicines offering significant clinical benefit sit on Pharmac's waiting list today - most have been there for many years.

* Modernise Pharmac's procurement processes. Consider the value medicines bring to patients, the health system, and society as a whole instead of viewing medicines as a sunk cost. If we do this, some medicines will align with the Finance Minister's Social Investment policy.

* Implement an empowered and transformational SLT to lead Pharmac (as opposed to manage it) and create a patient-centric agency which sits inside the health system, and is laser-focused on reform, and improving health outcomes.

I was buoyed to hear Sir Brian Roche's speech at the Forum and the emphasis he placed on improving leadership capability within the Public Service, and procurement processes.

Finally, our government is rightly focused on improving productivity - but if you want to improve productivity, you must also invest in the health of the humanity which is driving it. Medicines, and the health of our workforce, is fundamental to New Zealand's success.

31/05/2024

Steven Joyce, thank you.

"The one significant blemish that may dog the Government is its inexplicable failure to make good on its cancer drugs promise. It seems weird that you can trumpet a massive $17b increase in health spending across three Budgets and yet not dedicate any of it to meeting the most public health pledge of your recent election campaign...I’d bet this will be fixed in short order, as ministers have clearly missed the significance of this omission."

Please, can we now get this fixed?

OPINION: The failure to make good on the cancer drugs promise is inexplicable.

30/05/2024

Zero money for cancer medicines. Zero.

I don’t know what to say or how to process any of this. My phone is running hot with calls from patients and patient advocates and I can’t explain what’s just happened. I don’t have any answers.

In October last year, patients voted on a promise. It’s here in National’s pre-election manifesto. And many of us watched yesterday’s Budget waiting for an announcement on cancer drugs. It never came.

Yes, Labour left Pharmac in a perilous state by not forward-funding medicines into future budgets. This is what’s called the ‘fiscal cliff’. The new Government has been forced to find that money or stop funding the current schedule of medicines.

But in the $16.7b that Nicola Willis allocated for healthcare, there is no mention of cancer medicines.

Many of us were anticipating a $70m annual injection. Me? I had anticipated a $280m ring-fenced cancer budget spread over four years. But there was nothing. Not one dollar.

More than 25,000 New Zealanders will be diagnosed with cancer this year. Tens of thousands already have a diagnosis, and were holding out for this Budget. What do they do now?

The Government cannot stay silent on this. Cancer patients need an explanation and a timeline. Today.

27/05/2024

Succinct pre-Budget report from Jenna Lynch on Newshub tonight. What a mess we're in.

Our medicines waiting list is impacting more than 200k New Zealanders. Pharmac needs major reform, funding, and fresh leadership because it is foolish to think we can solve a problem with the same people who resided over it.

Operational reform, a new culture, and fresh thinking - and soon.

All eyes are on this week's Budget to see if National will keep its promise to fund more cancer drugs.

15/05/2024

This is a terrible situation - Pharmac has funded this medicine, but MS patients can't access it. Can you imagine the anguish and unnecessary stress this is causing patients?

Pharmac confirmed it would fund this medicine in September 2023. Eight months later, patients still aren't being treated with it - particularly in the South Island.

It is an incredulous situation that the taxpayer is funding this medicine, and MS patients are continuing to endure deteriorating health...and all because no-one is talking to each other.

This is (yet another) example of a dysfunctional siloed agency.

In 2023, Pharmac could have signalled it's intention to the Ministry of Health and Te Whatu Ora that it was looking to fund this treatment and they could have sourced the 3-4 staff we need to administer this medicine. But they didn't.

Where is the leadership?

A drug that can halt the effects of multiple sclerosis was funded by Pharmac but cannot be administered because some hospitals say they are under-resourced

05/05/2024

Professor John Zalcberg, the Head of Monash University’s Cancer Research Programme, said it best in Wellington last week.

“Get in the room. You can’t fix this issue unless you collaborate.”

Zalcberg was among some of Australia’s most talented medical experts who attended the Valuing Life Medicines Access Summit in Parliament. He sat among a posse of big medical brains who had no interest in being there except to offer some much-needed guidance and expertise to New Zealand’s growing medicines crisis.

Professor David Thomas was there too. He leads OMICO which fast-tracks Australia’s access to next generation cancer treatment and prevention strategies. Thomas brought decades of experience in medicine, oncology, and precision medicine and he agreed with Zalcberg – New Zealand will achieve nothing unless there is a political will to collaborate with the industry.

The early signs from David Seymour, the Associate Health Minister (Pharmac) is that he is listening. He’s engaging and isn’t afraid to get in the room with the companies who are driving innovation and the revolution in healthcare.

Seymour was instrumental in bringing all stakeholders into Parliament for the Summit, working with Patient Voice Aotearoa and Medicines New Zealand to create a first for our country. It shows a shift in the Wellington mindset from "we are lucky to have Pharmac" to "we recognise we have an issue". That, in itself, is progress.

Pharmac, to their credit, fronted too.

However, the elephant in the room remains - funding. Little can be achieved unless there is a far greater investment in health, and strong, patient-centric leadership which is focused on improving health outcomes and not simply crushing costs. Seymour committed $6.3b over four years to address Pharmac’s fiscal cliff, and a couple of new medicines, but that is all.

Our waiting list for medicines is staggeringly long – and plenty more medicines should be on that list too.

In time, I hope Seymour will look at system-wide reform because improving our medicines access is just one part of the equation. The rest of the world is getting ahead of disease and disorders with accurate diagnostics, genomic-lead healthcare, and precision medicine. These are all vital pillars of care in a modern health system, but they remain absent from ours.

Bravo to all who attended, but particularly to Fiona Tolich and Emma Purchase who so eloquently spoke of their fight to be seen and heard by Pharmac.

The new Pharmac Chair, Paula Bennett has a bit on her plate. Is it a political appointment? Yes. Of course it is. But, unlike her predecessor, I don’t think Bennett has been appointed to mitigate media risk for the Government. She wasn’t shoulder-tapped for the role, she asked for. To that end, we should judge her by her actions and Lord knows, she’s got a bit to be getting on with.

22/03/2024

David Seymour puts his cards on the table in an interview with Nicholas Jones at The Herald. The Minister outlines the Government's plans for Pharmac, and if they come to fruition we are on the precipice of genuine reform.

+ we now have direct political accountability with the appointment of David Seymour as Associate Minister of Health (Pharmac) ✅

+ the Government wants Pharmac to take a whole-of-society approach to funding. This is the big one. If we can modernise and reform Pharmac's funding methodology, it will free up funding, ease the burden on our hospitals, and improve patient access to medicines. ✅

+ there is a strong focus on funding medicines which improve productivity. This is important. But we mustn't lose sight of medicines that ease suffering and provide families with a little more time. Productivity is important, but so is humanity. If we can support New Zealanders to live with dignity when they are suffering from a disease or disorder, then we should. ❤️

+ There is the potential for a cost-sharing arrangement with patients. Yes, we want drugs fully-funded, but some cancer and rare disorder patients have raised the prospect of cost-sharing in the past. Pharmac could use its strong negotiating powers to secure a good price, and then split the cost with a patient. It is a sign of some out-of-the-box thinking by the Government. ✅

+ there will be no "record increase" in funding for Pharmac this year because some of Pharmac's past budget increases haven't been funded into the future. This is true. It means the Government will have to find additional budget just to ensure the current drug schedule is funded. I understand the country's fiscal position, but this is disappointing. Pharmac's waiting list is huge. ❌

+ Finally, when pushed, Seymour says he has confidence in the CEO which will be very confronting for many patients and advocacy groups. However, Seymour will be walking the line on this issue. The Government can not (nor should it ) interfere with the structure of Pharmac's SLT. This is the role of the Board and the newly appointed Chair. However, it is a given the new Chair will understand the importance of prioritising significant cultural reform at the top end of Pharmac. Change is in the wind. 🙏

Seymour wants investigation of possible cost-sharing between Pharmac and patients.

12/03/2024

Forgive the misleading headline (although it is fantastic that Pharmac will finally consider medicines which are still being approved by Medsafe) but we have so much to thank Dr Ruth Spearing for.

Dr Spearing has been tireless in her advocacy for greatly improved access to blood cancer meds, and she juggles her important clinical work while continuing to hold Pharmac's feet firmly to the fire.

More funding is needed and we will continue to stand still until we reform Pharmac's funding methodology. New Zealanders are so deserving of truly world class leadership and governance at Pharmac as this opinion piece so clearly articulates.

Bravo Dr Spearing! Keep going. Reform MUST come.

OPINION: Kiwis will see new cancer drugs at a faster rate.

08/03/2024

Thank you for your advocacy, Kate! New Zealand can do so much better. The Malaghan Institute is doing remarkable work. Please understand their work and support if you can 🙏

10/01/2024

Sometimes people ask me about the drugs on Pharmac's waiting list. What's on the list? How big is it? Who's being left behind?

So here is the list.

There are well over 100 drugs and devices on Pharmac's waiting list to treat the following conditions. Some of these medicines have been on this list for years.

+ schizophrenia
+ prostate cancer
+ Fabry disease
+ rheumatoid arthritis
+ bladder cancer
+ multiple myeloma
+ bowel cancer
+ Type 1 diabetes
+ breast cancer
+ lung cancer
+ kidney cancer
+ liver cancer
+ several forms of leukemia
+ post-op induced vomiting
+ ring pessarys for pelvic prolapse
+ invasive Pneumococcal disease
+ Respiratory Synctial Virus
+ Meningococcal A, C, Y and W-135 vaccines for children and teenagers
+ Prader-Willi Syndrome
+ asthma
+ Conn’s syndrome
+ Hodgkin lymphoma
+ colon cancer
+ herpes
+ gout
+ gastrointestinal tumors
+ re**al cancer
+ cervical cancer
+ head and neck cancer
+ facial angiofibromas
+ eczema
+ osteoporosis
+ ovarian cancer
+ flexural or ge***al psoriasis
+ plaque psoriasis
+ mantel cell lymphoma
+ anaemia
+ UTI’s
+ focal epilepsy
+ Crohn’s disease
+ PKU
+ short bowel syndrome
+ ulcerated colitis
+ Tyrosinemia Type 1
+ basal cell carcinoma
+ influenza vaccine
+ atopic dermatitis
+ growth hormones for short stature
+ hyperammonemia
+ treatments for opioid dependence
+ treatments for severe drug-resistant infections and eye infections
+ palliative drugs for opioid-induced constipation
+ hypercalcemia
+ Ketamine for emergency use in primary care
+ pancreatic cancer
+ thyroid cancer
+ drugs to treat severe infections following bone marrow transplants
+ developmental and epileptic encephalopathies
+ cardiovascular issues including chronic heart failure
+ a range of drugs to treat a number of auto-immune conditions

And there are plenty more drugs which should be on this list too.

20/09/2023

October 4th. Put it in the diary if you’re in Auckland. This will be a chance to hear what the political parties will do to address our unfunded medicines crisis.

🦠🧪The MyLifeMatters Roadshow, New Zealand's Medicine Crisis, is making its final stop in Auckland on Wednesday 4th of October!

This event will feature a debate involving five prominent political parties, with the discussion moderated by the experienced Guyon Espiner. It presents a unique opportunity to delve into the pressing issues surrounding the medicines crisis in New Zealand.

• Hon Dr Ayesha Verrall (Labour)
• Dr Shane Reti (National)
• Jenny Marcroft (NZF)
• Ricardo Menéndez March (Greens)
• Todd Stephenson (ACT)

Auckland:
📍Venue: University of Auckland Library in Room B28, Princes Street, Auckland CBD
⏰4th October commencing at 6.30pm

This is an extraordinary opportunity to engage directly with five major political parties, guided by a seasoned moderator who will ask the hard-hitting questions about Pharmac reform and the medicines crisis in New Zealand. Wouldn't it be great if we could pack the library to capacity!

Come and join us, RSVP to the event below:
https://www.facebook.com/events/272338532394757

12/09/2023

So delighted to see this. Wiki’s advocacy saved and elongated the lives of so many women, and right now her husband Malcolm Mulholland is on the campaign trail with mylifematters.org.nz

Arohanui 🙏💕

The Civic Honours Awards celebrate and recognise the wonderful groups and individuals who have given many years of outstanding voluntary service.

This year Wiki Mulholland has received a posthumous Civic Honours award for Health and Welfare.

Wiki Mulholland was an advocate for young people throughout her life, and became known nationally for her passionate advocacy for better access to cancer drugs.

Her work to improve and extend the lives of people with cancer, along with her tireless efforts to help others in many other areas, was recognised with a posthumous Public Service Medal in July this year.

In her younger years, after leaving Hastings Girls High School (where she was head girl) in 1995, she went on to be a member of the Prime Minister’s Youth Advisory Forum and represented New Zealand at the Commonwealth South Pacific Youth Advisory Forum from 1999 to 2002.

After completing a BA (Political Science) at Victoria University she returned to Hastings and was employed as the Hastings District Council’s first-ever youth co-ordinator from 1999 to 2002.

During that time she accomplished many projects including establishing the Hastings Youth Centre that opened in 2000, the first Hastings Youth Expo, the first Children’s Day celebrations in Flaxmere, the Hawke’s Bay Youth Workers collective and she helped get Hastings’ first skatepark built.

After being diagnosed with advanced breast cancer in 2018, she headed a campaign to get the drugs Ibrance and Kadcyla funded – ultimately achieving success when Pharmac announced both drugs would be funded in 2020.

Throughout the journey, until she sadly passed away in November 2021, she alongside her husband Malcolm Mulholland, founded Patient Voice Aotearoa.

Over her life she dedicated hundreds of hours of voluntary work that has stood the test of time and still makes a difference in people’s lives today.