An advocate for increasing Pharmac's budget says he's long been a personal friend of the Prime Minister, but she no longer replies to his calls or texts.
Malcolm Mulholland, chair of Patient Voice Aotearoa, says all he wants is half-an-hour with Jacinda Ardern so he can explain why the drug-buying agency's budget needs to be dramatically expanded, and hear her explanation why it won't be.
The Government on Tuesday announced it would be launching a review into Pharmac, but its total budget wouldn't be part of that. Instead it will only look at how it performs against its objectives, concerns around transparency, how quickly it makes decisions and whether they are equitable.
"Prime Minister, Jacinda, we've known each other now for over a decade, since you entered into politics. You know myself, you know Wiki, you know our kids," Mulholland said on The AM Show on Wednesday. Wiki is his wife, who has been battling advanced breast cancer.
"We couldn't have been prouder when you were elected as the Prime Minister - we screamed from the top of our lungs, we said yes, finally, someone who's in there from our generation - we couldn't have been prouder," he continued.
"But ever since we have been speaking out against Pharmac, the communication trail has gone cold. You don't return texts or calls. You know where we live - why don't you come around, have a cup of tea? Let's sit down and just have a talk. There's no harm in doing that.
"You know how to reach me. Please, we'd love your ear for half-an-hour."
Pharmac's budget each year is decided by the Minister of Health, after consultation with the agency, the Ministry of Health and district health boards. In the 2019-20 financial year, Pharmac spent $1.04 billion on medicines, up about $19 million from the year before.
Around $625 million was saved, according to Pharmac's annual review, thanks to deals it can cut with providers as a single-buyer. Pharmac says keeping costs down allows it to fund a wider range of medications, and since its formation in 1993, its purchasing power has tripled.
But research in 2019 found New Zealand came last for access to priority medicines in the OECD - taking twice as long as the average to get medicines funded, and having the least number available.
A decade ago, Pharmac's budget was $710 million.
New Zealand's Government spending on health per capita is middle-of-the-pack in the OECD, at about US$3343 a year. But with Pharmac's budget of about $1 billion, that places us near the bottom for pharmaceutical spending as a proportion of the health budget.
Mulholland said Pharmac was underfunded when compared with other nations' drug-buying agencies, and wants the budget tripled.
"It's great if you're not sick. If you're sick, it's a dog - let's call it what it is."
Other inquiries launched by the Government recently - including those looking at welfare, mental health and addiction and the health system - were allowed to analyse whether their budgets were high enough, but Pharmac's review won't.
"Each one of those reports actually had as part of its terms of reference to take a look at the budget and whether or not it was fit-for-purpose. They didn't just exclude it yesterday - they actually noted that Pharmac's budget is off the table in terms of this review."
Heather Simpson - who led the review into the health system, has worked on improving New Zealand's COVID-19 response at the border and spent decades working for Helen Clark - is on the Pharmac review panel, which will be led by former Consumer chief executive Sue Chetwin.
Mulholland called Simpson a "Labour lackey".
"She might be a health economist by trade, but I know plenty of others who are more qualified and have more experience who could probably conduct a better review into Pharmac."
Health Minister responds
Health Minister Andrew Little rejected Mulholland's criticism of Simpon's participation.
"There are six people on the review panel - Heather Simpson as a health economist is just one, but we want a health economist and she has a strong reputation in that area.
"We also have people with a clinical background; a pharmacist prescriber and a medical health academic who is also a GP. The review is chaired by a long-standing consumer advocate. The reason we put Sue Chetwin in this position is because she represents those who are users of services and will bring that perspective too."
He said the overall budget wasn't part of the review because "they know that there is no sum of money that will ever be enough to provide all of the medications to meet all the needs of every person".
"In the end the budget, like the rest of the health budget and the rest of the Government budget is a set of political decisions and political trade-offs and that's why it doesn't make sense to review that.
"What we want to know is that when Pharmac is making its decisions, that it is doing so in the best way possible."