By RON TAYLOR
An 81-year-old Auckland woman with terminal stomach cancer is paying for her painkilling drug because it is not subsidised by the Government's drug-buying agency, Pharmac.
It costs her $325.25 a month for 10 doses of Durogesic (transdermal fentanyl), which is administered by a body patch and must be replaced every three days.
Though she says she has enough money to meet the cost, she worries that there are patients who cannot pay and may be denied the most suitable drug to ease their pain.
She does not want to be publicly identified. She is a widow, has six children, 29 grandchildren and seven great-grandchildren.
She was first diagnosed with terminal cancer more than 2 1/2 years ago with a life expectancy of six months. But she has a strong will to live and a strong Catholic faith - "I'll go when God wants me and not beforehand," she says.
However, she suffers chronic pain which has not been relieved by morphine. It caused severe side-effects which caused her to be hospitalised.
In April, her palliative care specialist, Dr Alan Farnell, of Auckland, decided to prescribe Durogesic, which is 100 times more potent than morphine but lacks its side-effects of severe constipation, nausea and sedation.
The result was so dramatic that she has returned to her own home with a quality of life that has enabled her to fly to Nelson to visit family and plan a trip to Sydney to see her latest great-grandchild.
"I'm just thankful that I am fortunate to be able to pay, but I worry for those who can't. It's terrible, it's not right," she says.
Durogesic has been available here in patch form for over two years. It is marketed by Janssen-Cilag, which applied to Pharmac in April last year to classify the drug for subsidy.
One of the woman's daughters has written to Pharmac asking why the drug is not subsidised, given the improved quality of life it can offer.
Pharmac's written response has been that Durogesic is rated as a "moderate priority".
A letter dated June 14 this year states "budgetary constraints" are such that Pharmac is not able to make new investments which "would result in additional costs to the pharmaceutical budget".
However possible negotiations with the supplier "may yet result" in a proposal acceptable to the Pharmac board.
It was also pointed out that in certain circumstances a patient may apply to the Health Ministry for "exceptional circumstances funding" for a drug when alternative therapy is not suitable.
David Pascoe, a spokesman for Janssen-Cilag, said there had been no progress in the company's negotiations with Pharmac since last year.
Dr Farnell, who until recently was medical director at St Joseph's Mercy Hospice and is now in private practice in Auckland, says the cost of subsidising Durogesic is low given the relatively small number of patients for whom it would be prescribed.
He said fentanyl had been available for more than 20 years but the great advance had been its adaptation to administration by patch.
"It's a wonderful achievement because none of the others can be administered by a patch to the skin.
"Other medications come in either pill or liquid form, or both, and sometimes morphine, for example, is delivered by pump. So the fentanyl patch truly is an addition to the quality of care we can extend to the cancer patient in pain.
"One of the great human fears is dying in pain, but cancer pain is something we can control and even stop.
"So it's distressing when we can't offer the medication we know to be the best.
"Sometimes it seems wrong even to tell patients of the alternatives because we know they can't afford it."
Dr Farnell said ketamine was an example.
"It has a unique role in relieving pain caused by nerve compression in cancer. We haven't got anything equivalent to it but patients are being charged between $30 and $40 a day to receive it. That shouldn't happen."
Cancer patient's choice: pay or suffer
AdvertisementAdvertise with NZME.