Health New Zealand backtracks on Keytruda delay, will allow early access to some patients

Health New Zealand Te Whatu Ora has backed down on a plan to delay free access to a life-extending cancer drug after a backlash by patients and advocates.

Chief clinical officer Richard Sullivan said today that Health New Zealand would allow a small group of cancer patients to get early access to the medication Keytruda before Pharmac begins funding it later this year.

The Government is set to fund pembrolizumab, or Keytruda, for five more cancers: head and neck, triple negative breast cancer, colorectal cancer, bladder cancer and Hodgkin lymphoma – which can cost around $100,000 when unfunded.

Pharmac funding for the five extra types of patients was due to start in October, but drug company Merck Sharp and Dohme New Zealand has been working on an early access programme (EAP) so eligible patients can be referred by doctors to receive the medicine for free before then.

Health New Zealand had previously said it would not provide the treatment earlier as it would not be appropriate when wait lists are being assembled based on clinical need.

Advocacy groups described that decision as “gutting” and “deeply disappointing”.

Sullivan said today that work had been under way for national implementation in seven weeks’ time.

“Further advice from Health NZ clinicians has confirmed we could manage the small number of patients concerned ahead of 1 October.”

Between 20 and 30 patients were likely to get early access from this month. An estimated 300 patients are expected to be eligible once Pharmac funding begins.

Sullivan said Health New Zealand was growing the workforce and putting infrastructure in place to handle the additional need in the public system.

“Clinical leadership in both public and private healthcare are working together to ensure the safe transfer of patients who have been receiving the drug privately.

“Patients will have to undergo the normal steps and preparation with their treating clinician, a process which can take a few weeks.”

Merck Sharp and Dohme oncology director Vanessa Gascoigne had previously raised concerns with Health New Zealand that patients diagnosed in the next two months may be started on less effective treatments, and that this could affect their eligibility to then receive Keytruda once funding was available.

She also noted treatment with Keytruda was less resource-intensive than current treatments as it required shorter infusion times and fewer appointments compared to chemotherapy.

Keytruda will be funded from October 1.

“We are told that some Health New Zealand oncology services across the country could deliver pembrolizumab now, despite the national plan not being ready for all areas,” Gascoigne said.

“I would like to propose that instead of a blanket one-size-fits-all instruction from Health New Zealand’s national office, that medical oncologists/haematologists are empowered to put their patients forward on to the programme on a case-by-case basis.

“I hope that by highlighting this important issue, a sensible solution which prioritises eligible cancer patients can be agreed upon.”