Cancer drug Keytruda costs $70,000 more for some Aussies due to unfair subsidy rules

The stories of Graham Page and Ian Hart in South Australia highlight a major failure of our health system which lags the world in funding lifesaving treatments.

Exclusive: They have the same form of cancer and a breakthrough drug has saved their lives.

But, in a jaw-dropping discrepancy, one was treated for free and the other paid more than $70,000 for the medicine.

The stories of Graham Page and Ian Hart highlight a major failure of our drug subsidy scheme which lags the world in funding lifesaving immunotherapy treatments Keytruda and Opdivo.

The Therapeutic Goods Administration (TGA) has approved Keytruda for 26 cancer types but it is only funded by our medicines subsidy scheme for 15.

Graham Page, 84, has bowel cancer with a gene fault known as mismatch repair deficiency (dMMR). His cancer treatment is subsidised by the government.

Ian Hart, 76, also has cancer with the same dMMR gene fault but his cancer is in the pancreas and there is no subsidy for Keytruda’s use in pancreatic cancer.

He had to sell his home and spent $7200 every three weeks on the treatment.

Graham Page and Ian Hart have the same cancer, one had to pay (over $70,000) and the other didn’t, thanks to an inequitable Government funding model. Picture: Tom Huntley

Oncologist and Adelaide University Professor Tim Price who treats both men said even though their cancers were in different organs, Keytruda targeted the gene mutation common to them both.

The problem is “you’ve got a (subsidy) system that doesn’t really understand that targeted approach,” he said.

Pancreatic cancer has one of the lowest survival rates of any cancer and, when diagnosed, Mr Hart was told he had just three months to live.

Thanks to the breakthrough drug he is still alive 11 years on.

He is well enough to play lawn bowls and has been on several trips to Europe to catch up with family.

“I didn’t have that sort of money so I had to borrow the money until I sold my house,” he said.

“Anybody who didn’t have that money. Oh, my goodness. I felt sorry for them,” he said.

He spent $70,000 on the treatment before the pharmaceutical company that makes the drug gave him access for free under a program that caps how much a person spends in a lifetime if they are still responding to the treatment.

Mr Graham, who is well enough to ride his bike 40 kilometres twice a week and walks 15 kilometres on another two days, said “it’s probably not fair” his treatment was subsidised but Mr Hart’s was not.

Graham is able to ride 80 km a week while using the treatment, Ian plays bowls. Picture: Tom Huntley

The government committee that decides which medications get a government subsidy currently has to individually approve a subsidy for each different type of cancer – a process that takes on average 447 days for each indication.

In November, the committee ruled a subsidy for Keytruda across multiple cancers “would be appropriate with a risk sharing arrangement” but it said the pharmaceutical company would have to drop the price of the treatment.

The pharmaceutical company MSD has offered a substantial price cut but five months on still waiting to hear what further detail the government requires in order to approve funding.

“We look forward to hearing from the Department of Health and PBAC on how we can progress this matter and make Multi-Cancer Funding a reality for Australian patients as soon as possible. We know that patients with cancer often don’t have time to wait, so it’s important we collectively act with urgency to ensure Australians living with cancer don’t miss out on affordable access to immunotherapy,” the company said in a statement.

A Health Department spokesperson said “the department remains open to continuing dialogue with the responsible pharmaceutical companies to support them in resolving the outstanding issues so that a broad PBS listing for these medicines can be reconsidered by the PBAC”.

Eleven cancer groups are pleading with Health Minister Mark Butler to support of a multi-cancer funding proposal for these types of immunotherapy.

They say 3500 more Australians would be eligible for treatment if our drug subsidy scheme funded all indications that are currently approved in the US.

Mr Butler was asked to comment.