Newshub can reveal Pharmac has a budget hole hundreds of millions of dollars deep.
For the first time, the Government's drug-buying agency has released figures about its 'options for investment' list - medicines Pharmac would pay for if it had the budget.
There are currently 73 medicines on the list. The cost of funding every drug on the wish list is more than $400 million a year - $417,670,000.
Kiwis like Andrew Speir rely on the goodness of strangers to get necessary medicine. The 36-year-old has stage four bowel cancer and doctors recommended he use Avastin, a drug not funded for bowel cancer in New Zealand.
His parents were burning through their life savings to pay for it. His friends fundraised enough for a years' worth - $44,000 - through Givealittle.
"I can't fathom how people can be so generous," Speir told Newshub.
On top of paying for the drug itself - Speir pays fortnightly to have it administered.
"Once the drug is paid for, if it can get administered publicly, we would live longer and live better lives and actually not have to worry about a bill every week, every fortnight, just hanging over our heads," he says.
But Avastin is not on the Pharmac funding waitlist.
Newshub has obtained the number of drugs on Pharmac's options for investment list. It's the first time Pharmac has released these numbers - basically a wish-list of drugs they would fund if their budget allowed it.
So, if the Government opens the piggy bank and pours in more cash, Pharmac would fund the medicines.
"We do the best we can with the budget we've got and we're always looking to make improvements and to fund more medicines as best we can," Pharmac CEO Sarah Fitt told Newshub.
The waitlist is split into proposals and medicines. The reason there are more proposals than medicines is that some drugs can treat multiple illnesses.
In 2014 there were 27 proposals for 26 drugs. It has increased steadily every year since, peaking in 2020. There are currently 118 proposals for 73 medicines.
"This Government has increased the Pharmac budget to over a billion dollars a year now," Health Minister Andrew Little told Newshub. "We know there are a lot of medicines out there that it would be desirable to fund, but there is always a limit."
There's a political limit on funding - which means we wait.
Of the 118 proposals, 16 have been on the list less than two years, while 64 have been there from two to four years, 25 for four to six years, and 14 proposals have been sitting there waiting for funding for more than six years.
"New medicines come onto the list all the time so they end up coming onto the list higher up so those medicines, unfortunately, do sit further down the list," Fitt says. "The Government of the day makes the decision on how much funding they will give us."
It's prioritisation that wouldn't need to happen if they had the money they need.
Newshub asked the Health Minister if it's essentially a budget hole.
"Yeah, the budget decision is a political decision and that's why this Government is now funding Pharmac to over a billion dollars a year and we've made commitments about wanting to keep pace with Pharmac."
The decision comes down to him and Finance Minister Grant Robertson.
The price tag on that decision: $400 million a year - that's what Pharmac needs in this year's Budget to fund all the drugs sitting on that wish list. It's about a 40 percent increase in its budget.
"It would be very rare for that to happen," says Little.
"That said we know that there are treatments that are not funded at the moment. We are always looking at ways that we can find ways to fund those treatments. In the end, those are Budget decisions and that's for next month."
Patient Voice Aotearoa chair Malcolm Mulholland has continuously called for Pharmac's budget to be increased.
"Unless they do that, Pharmac's going to continuously have this gaping hole and that hole results in lives being lost," he told Newshub.
Last year Pharmac didn't even ask for any more money in the Budget. The year before, it requested an extra $10 million dollars a year - not even scratching the surface of its $400 million dollar wish-list.