Pharmac is defending its position to not fund a drug recommended to patients with late-stage bowel cancer who react severely to regular chemotherapy drugs.
Photo: 123rf.com
The patients' doctors have recommended an alternative drug - Tomudex - not funded by the national drug-buyer, which they can only get if they pay for it privately or qualify for funding under the "exceptional circumstances" model.
Director of operations Lisa Williams said 250 patients a year could potentially react to standard medication so those that do are not exceptional and do not qualify for special funding.
She said in late 2016 Pharmac was advised reactions were common.
"We wrote to the DHB that had been putting in most of the applications previously and said 'this doesn't look like an exceptional situation' and we encouraged them to put in a funding application for the product to be listed in the schedule.
"We received a funding application on Monday this week."
Ten applications have been made by individuals for the drug since 2012.
Ms Williams said Pharmac did not follow up with the DHB on advice from its clinical advisory group.
"We spoke with our cancer clinical advisory group and asked them if it was an urgent thing that we should be progressing.
"Their advice was that we should wait for the specialist doctors to make a funding application, because that would tell us whether or not this was something that was of general interest."
She said she was unsure if Pharmac had consulted directly with bowel cancer oncologists.
"We did consult with our expert group of oncologists, but I'm not aware if we consulted with [bowel cancer oncologists] or not.
Auckland woman, 50-year-old Patricia Tear, a sole caregiver to children aged 9 and 11, was diagnosed with bowel cancer last year.
She had surgery followed by chemotherapy but suffered from cardio-toxicity from the drug, known as 5-FU. It recurred in a second attempt and doctors decided it was too risky to repeat.
Ms Tear applied to Pharmac for Tomudex under "exceptional circumstances" but was declined.
Ms Williams said Pharmac received about 1400 exceptional circumstances requests each year but they had to only consider the patient's health situation. .
"Pharmac's acutely aware that all New Zealanders are in some way, and at some time, affected by the funding decisions... it's our job to ensure that our decisions are as fair and as robust as possible using clinical advice.
"What we're keen to do is make sure we're looking at the person's health situation and making sure that we're being consistent in the way that we approach funding to make sure all people experiencing the same situation - from a health perspective - are treated equitably."
