The Cancer Control Agency says New Zealanders are missing out on many potentially life-saving treatments.
The agency has identified 20 different gaps across nine different cancer types where the medicine was publicly funded in Australia, but not in New Zealand.
But a breast cancer survivors' charity said the report vastly undercounted how many worthwhile drugs were unavailable for patients facing financial pressure and stress.
And for Dr Malcolm Mulholland, there's nothing abstract about the issues raised in the agency's new report.
In May 2018, his wife Wiki was diagnosed with breast cancer.
Drugs were available to extend her life but the best were not publicly funded. One called Ibrance, known to be effective, cost $5800 a month.
Wiki died last November, just 43 years old.
Malcolm has said the lack of public funding for Ibrance led to the Manawatū family dipping into fundraising, KiwiSaver, and his wife having to wait for the effective drug.
"Some of the research indicates you are better to have it as a first line of treatment," he said last night.
"We had to wait for the decision to be made and then Wiki received it. I think it was her fifth line of treatment."
Malcolm, a Massey University historian, said he and some colleagues had conducted their own study of funding gaps and found 89 unfunded medicines just in tumour cancer types.
"We've been saying for some time that we have a medicine crisis. It's right across the board. There are a host of drugs that aren't funded here that are funded overseas."
Malcolm (Ngāti Kahungunu) said the Te Aho o Te Kahu/Cancer Control Agency report might at least raise some awareness of the funding shortfalls.
"You can only look at it and go: This is the extreme bare minimum of what we need to fund right now."
Mulholland said he knew many patients who had to privately fund, normally through the Givealittle website.
"It's a two-tier health system. One for the rich, one for the poor."
Te Aho o Te Kahu is a public agency reporting to the Minister of Health.
Its new report analysed what cancer medicines for solid tumours were funded in Australia compared to New Zealand – both in quantity and clinical benefit.
"Whether curative, or life-prolonging, people expect to have access to cancer medicines when they need them," Te Aho o Te Kahu chief executive Prof Diana Sarfati said.
"For a number of years, there has been a concern Aotearoa is lagging behind other comparable countries when it comes to the funding of cancer medicines."
The agency said in each funding gap identified, it was clear the medicine would offer substantial clinical benefit.
Three gaps identified were for use in the curative context, meaning medicines used alongside surgery with the intent to cure.
The other 17 were in the non-curative context, when medicines were intended to extend a person's life or improve quality of life, even in incurable cancers.
"We hope to extend this analysis to include medicines for blood cancer as soon as it is feasible to do so," Sarfati added.
The Breast Cancer Aotearoa Coalition said it was deeply disappointed at the report, because it greatly underestimated how many drugs were not being funded.
"There are 18 breast cancer medicines funded in Australia and not in New Zealand," the coalition said.
"We're stunned to see that Te Aho o Te Kahu has identified only one breast cancer drug as needed but not funded in New Zealand."
It said countless New Zealanders faced the pressure of making hard financial decisions about health care on top of the stresses of dealing with cancer.
"New Zealanders who can afford to pay for their medicines in private clinics receive better care and live longer, healthier lives."
It said Te Aho o Te Kahu's report used a "complex and opaque process undertaken behind closed doors" to justify continued rationing of cancer medicines.
"Cancer takes many forms and there are multiple subtypes of breast cancer," the coalition said.
Pharmac had assessed or was assessing most of the drugs identified in the Te Aho o Te Kahu report.
And since the study, Pharmac approved two of the non-curative medicines for funding.
Those two were durvalumab (also known as Imfinzi) for a type of lung cancer, and olaparib (Lynparza) for a type of ovarian cancer.
Pharmac said it welcomed the new report.
Chief executive Sarah Fitt said the analysis provided useful insights into a complex healthcare area.
"Te Aho o Te Kahu has rightfully identified that there is still work to be done to improve access and outcome equity for New Zealanders affected by cancer," Fitt said.
"Both Pharmac and this report are focused on how much clinical benefit is offered by cancer medicines rather than just the volume of funded medicines," she added.
"The report also acknowledges the benefit of preventative activities and diagnosing cancer early."
Malcolm Mulholland said the issue was ultimately political - largely dependent on Pharmac getting more funding for treatments.
"They should have been funded years ago."