How a key campaign pledge came undone.

August 21, 2023: The big promise is made

Two months out from the election, National promises that if elected, it will fund 13 treatments for lung, bowel, kidney and head and neck cancers that New Zealand’s Cancer Control Agency has identified as providing substantial clinical benefits, and that are currently funded in Australia but not in Aotearoa.

“Under National, New Zealanders will not have to leave the country, mortgage their home, or start a Givealittle page to fund potentially lifesaving and life-extending treatments that are proven to work and are readily available across the Tasman,” says the press release announcing the pledge.

To pay for the treatments, $280 million ring-fenced funding will go to national drug-buying agency Pharmac over four years – $70m per year, starting with the 2024/25 year (which begins on July 1, 2024). This funding will come from reinstating the $5 prescription fee for most people. “This change will reduce the cost of the prescription subsidy by approximately $316 million over four years, which we will use to fund our investment in 13 new cancer treatments. The remaining savings will remain in the health budget,” says National. A table in the policy document released at the time shows how it will work:

The announcement is welcomed by the likes of the Cancer Society, but it also cautions that infrastructure (staff and space) will need to be funded too to ensure the treatments can actually be delivered. Oncologist Kate Clarke expresses concern about cancer therapy and Pharmac being used as “a political football”, and Luke Bradford of the Royal New Zealand College of General Practitioners accuses National of “political gamesmanship”, saying the plan to reduce spending on free prescriptions to fund new cancer drugs is a step backwards. Labour leader Chris Hipkins says, “I think we need to be careful as politicians about picking and choosing what drugs get funded.”

November 27, 2023: No mention in coalition agreements

There is no mention of the cancer drug funding pledge in the coalition agreement with either Act or NZ First, but both coalition partners agree to progress the policies set out in National’s fiscal plan that haven’t been changed by the coalition deals.

November 29, 2023: Not a priority for 100-day plan

Two days after the new coalition government is sworn in, new prime minister Christopher Luxon unveils a “100-day plan” of 49 actions it plans to complete in its first 100 days in office. The funding of the 13 cancer treatments isn’t included.

Early March 2024: Government goes ‘a bit quiet’, and questions are raised

In a series of reports by The Post’s Rachel Thomas, two oncologists, including one who co-wrote the report from which the list of 13 unfunded treatments was lifted, criticise the government for undermining Pharmac’s bargaining power. Instead of naming the specific drugs to be funded, it should have announced a funding boost for Pharmac and allowed the agency to get on with its job, “which is to prioritise drugs and get good deals”, Chris Jackson and George Laking say. It is noted by Laking that the government has “gone a bit quiet” on the promised funding, but he says he is confident it will be followed through on.

Health minister Shane Reti tells The Post there is still no timeline for when the 13 treatments will be funded, and doesn’t rule out making cuts to health elsewhere to fund the campaign promise. He hopes prescription fees will be reinstated this year, he says. “As soon as we can bubble up that funding then we can look at deploying it… We’ll know [based on] what we get from that whether we need to add further money to increase cancer drugs.” 

After suggestions that the list of drugs is out of date, and Thomas’s report in The Post as well as a piece in NZ Doctor reveal that several of the 13 treatments had been declined by Pharmac in the past, Reti says the list may change. 

April 1, 2024: No mention in the 36-point action plan

With the 100-day plan completed, the government announces a 36-point action plan to be completed by June 30. There is no mention of funding the new cancer drugs.

April 29, 2024: Pharmac funding announced

Associate health minister David Seymour announces that Pharmac will receive $6.294 billion in funding over four years, which it says addresses a shortfall of $1.77bn left by the last government. Pharmac says the funding increase won’t cover any new drugs and is only enough to “keep the lights on”. Cancer advocates call for further funding to be allocated in the budget.

May 16, 2024: Warnings are sounded

Cancer Society chief executive Rachael Hart tells Stuff it would be “an enormous breach of faith” if funding for the 13 promised drugs doesn’t eventuate. She also expresses concern over the government specifying a list of drugs it wants to fund. “We don’t believe it’s best practice to be influencing the decisions of Pharmac because of the risks of negotiating costs.”

Luxon tells Newshub while the government is “committed” to the pledge, “We have a lot to work through… We know there are more cancer drugs that need to get into the system, we will have more on that in the coming months.”

May 28, 2024: The writing’s on the wall?

Two days out from the budget and the government all but confirms the promised funding for the 13 cancer treatments is not coming, with Luxon saying, “We’re committed to that policy,” swiftly followed by, “We can’t do everything in that first budget, we had to deal with some surprises.”

May 30, 2024: The budget is released, with nothing for new cancer drugs

“We regret that it hasn’t been possible in this budget,” says finance minister Nicola Willis. Despite $70m being budgeted pre-election to fund the drugs this year, Reti argues the policy had always been that they would be funded through revenue from the prescription co-payments, which haven’t been reinstated yet. “My expectation is that when we have revenue towards year one from co-payments, then we’ll look as to whether we need further revenue from Pharmac and I’ll have discussions with my colleagues and then we’ll work with Pharmac to meet the obligations that we said we would,” he tells the Herald.

The government also blames “fiscal cliffs” left by the previous government meaning Pharmac needed a bigger budget boost than anticipated, as well as the policy requiring a “fundamental change” be made to how Pharmac operated. 

The Cancer Society is “deeply disappointed” and cancer patients pinning their hopes on the new drugs say they feel “betrayed”.

June 4, 2024: ‘Patients don’t have a year to wait’

A coalition of 15 cancer advocacy groups writes an open letter to the government. “Cancer patients and advocates sat in disbelief when the budget was announced,” it reads. “We have now learnt that those 13 medicines may not be funded for at least a year. Patients don’t have a year to wait and will sadly have to look at all the heartbreaking scenarios your party wanted to put an end to.

“We implore you to make good on your commitment to fund these 13 medicines with the utmost urgency.”

Luxon says procuring the drugs was an issue, and there would be an announcement on funding “this year”. Cancer patient Vickie Hudson-Craig tells RNZ, “To say ‘We’re going to announce something soon… it’ll be this year, we don’t quite know when’ – it’s not good enough for people who are dying.”

Oncologist George Laking questions the procurement claim, saying “The reason is financing… I think the thing everyone can see is the money isn’t actually on the table for this because if the money was on the table, then it would be obvious if the holdup was some aspect of Medsafe and then that could be worked through.”