New hope for cancer patients accessing leading-edge unfunded drugs

Peter Fergusson, CEO of Leukaemia & Blood Cancer New Zealand is heartened to hear that Pharmac has announced plans to back an Early Access Scheme which could potentially give cancer patients access to new and emerging medicines and treatments.

"Few cancer patients have time to wait, and many are prematurely dying because they do not always have access to the most optimal medication at the right time in their treatment cycle. Many of these emerging medicines and treatments are being fast-tracked, funded and made available in other OECD countries," says Fergusson.

Leukaemia & Blood Cancer New Zealand is part of a coalition of cancer NGOs called CANGO. A collaborative group of patient-focused cancer organisations that have proposed a Rapid Access Scheme to the government as part of the broader solution for improved cancer treatment in New Zealand.

Rapid Access Schemes have been introduced, and trialled, in the UK, and some European countries, initial versions of these schemes have not proven successful however recent iterations of these schemes have been streamlined and improved dramatically. New Zealand has the unique opportunity to learn from these experiences and adopt leading-edge best practice processes based on the successes from these proven and successful structures.

"We are looking forward to receiving the pending formal reviews of the UK Early Access Scheme to benchmark those learnings against the draft proposal submitted to the Health Minister. My hope is for the government to actively ring-fence funding for a pilot scheme from the May budget. It is hard not to ponder how many lives might be improved, prolonged and saved this year if a pilot Rapid Access Scheme was implemented within the next few months?" says Fergusson.

Since being elected, the government has confirmed cancer is one of its major health priorities.

"Cancer is New Zealand's biggest killer and is responsible for over 30% of all deaths each year. It is encouraging to hear Pharmac backing an innovative concept that could reduce cancer-related deaths. It begins to give hope that this will open the door to new and leading-edge treatment options. It shows that the government may be listening to the growing voice of concern and may also be willing to take action against a disease that has reached epidemic proportions in our country," says Fergusson.

Some medical experts say Phil Kerslake is New Zealand's longest surviving and most prolific cancer patient in New Zealand. Phil has been living with different cancers and its treatments since his teens - over 40 years.

Kerslake is encouraged by the prospect of a Government approved Rapid Access Scheme.
"In my case, there are few remaining treatment options, and my current treatments are viewed by doctors as palliative. The rapid evolution of new targeted therapies and immunotherapy has given me, and other patients hope for a better future.

I feel there is every chance that early access to some of the unfunded drugs in the pipeline will prove the difference between premature deaths and otherwise long, highly productive lives. I love my life and my family, and I hope to live to benefit personally from an emerging treatment. But if my good fortune is to end, I would dearly like to believe those following me have the opportunity to live on," says Kerslake.

Background

CANGO (the alliance of Cancer Non-Governmental Organisations) has adopted a position on improving the access to new cancer medicines and treatments in New Zealand. We call on this Government to urgently consider and implement changes for reasons of equity, evidence and deep concerns about the systemic underfunding of more effective cancer treatments. In our view, the existing decision processes disadvantage, delay or deny access to innovative treatments, such as targeted therapies and immunotherapy, that are now accepted abroad as the standard of care.

The Cancer Landscape
In 2018 more than 23,000 New Zealanders were diagnosed with cancer, of whom more than 9,000 are expected to die. Cancer is our biggest killer and causes 30% of all mortality in New Zealand.

Most cancer patients have no time to wait and many are dying prematurely because they do not have access to the right medicines at the right time in their treatment cycle. Many of these medicines are freely available in other OECD countries.
New Zealand ranks 19th out of 20 OECD countries for access to new medicines; just 23.5% of medicines registered between 2012 and 2017 in New Zealand have subsequently been reimbursed.

When comparing access to new medicines with Australia in the period 2011-2017[i], New Zealanders are severely disadvantaged:

- 24 new cancer medicines have been reimbursed in Australia but not in New Zealand

- The approval process takes considerably longer in New Zealand (190 days longer on average)

One of Labour’s pre-election pledges was to provide world class cancer care and a swifter process for funding new innovative treatments like targeted therapies and immunotherapy that are the standard in comparable OECD countries.

Since being elected, the Government has confirmed cancer is one of its major health priorities, although New Zealand has not yet seen a commitment to world class cancer care demonstrated in policy, nor an increase in funding nor an alternative access programme to clear the backlog of cancer treatments still sitting on the Pharmac waiting list.

We need to do better for our most vulnerable.

Rapid Access Scheme for Cancer Medicine

Under the current PHARMAC model, new cancer medicines typically take 3 years to be assessed for funding and there is also a significant backlog of unfunded medicines. Clearly the current system is detrimental to the wellbeing of cancer patients and many are dying needlessly or dying sooner than they should.1,2 [ii]

Public dissatisfaction with the lack of access many patients have to new medicines and treatment is growing - this has been demonstrated in public campaigns in the past for Herceptin (for breast cancer) and Keytruda (for melanoma cancer) and more recently in the petition presented to Parliament for Ibrance (again for breast cancer).

Additionally, media frequently report cases of patients needing to resort to funding schemes such as Givealittle to self-fund medicines and treatments that are available and funded in comparable OECD countries. Patients fortunate enough to have medical insurance rely on this to cover costs of their cancer treatment. We are fast becoming a two-tier society of "haves" and "have-nots" when it comes to cancer treatment increasing inequities in cancer care.

CANGO believes this is unjust and the situation needs to be addressed.
CANGO supports the development of a Rapid Access Scheme for new and novel cancer medicines and treatments. Such a scheme in UK (their version 2) is very successful and provides a model of what could be developed in New Zealand.

Again, we remind this Government of its pre-election pledge to introduce a Rapid Access Scheme for new cancer medicines and treatments and offer our knowledge and experience across the cancer spectrum in working with Government to resolve this issue.

About CANGO
CANGO (Cancer Non-Governmental Organisations) is an alliance of prominent New Zealand cancer charities including;
Breast Cancer Foundation, New Zealand Bowel Cancer New Zealand, Leukaemia & Blood Cancer New Zealand New Zealand, Gynaecological Cancer Foundation, Prostate Cancer Foundation of New Zealand, Unicorn Foundation New Zealand, Melanoma New Zealand, Lung Foundation New Zealand, Gut Cancer Foundation, Cancer Society of New Zealand.

The group was formed in 2007 in an effort to increase collaboration among cancer charities and to advocate on behalf of cancer patients and carers.

Member organisations meet regularly to discuss key issues facing the sector; to meet and share information with representatives from the Ministry of Health and others working in cancer-related areas; and to work together on specific initiatives that reflect the shared goal of all members to reduce the incidence and impact of cancer on New Zealand and New Zealanders.

[i] IQVIA Access to Medicines Report 2018 available from Medicines NZ 1 "I’m still here" Insights into living -and dying - with Advanced Breast Cancer in New Zealand 2 https://www.medicinesnz.co.nz/fileadmin/user_upload/Information_Leaflets/The-impact-of-pharmaceutical-innovation-on-New-Zealand-cancer-patients-extended-version2016.pdf;1.6.2016. 3 https://gicancer.org.au/news/john-zalcberg-chris-jackson-call-for-access-to-treatment-for-new-zealand-cancer-patients; 21.8.2018