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Monday, 18 March 2013
Page: 2450


Dr WASHER (Moore) (22:14): I rise to speak on an issue of great importance to the health of this nation. My concern arises out of the overt politicisation of the function of the Pharmaceutical Benefits Advisory Committee, the guardian of our Pharmaceutical Benefits Scheme. The PBS has until recently been the reference point for all countries with reimbursed medicines programs. The PBAC met on the last three days of last week to consider submissions lodged at significant cost to sponsoring companies. A major submission costs a company as much as $121,000 in fees alone, apart from all the direct and indirect costs associated with mounting these submissions. None of these fees or costs, incidentally, are invested back in the PBS. Yet the former health minister, Nicola Roxon, told this parliament that savings were needed to create headroom for desperately needed new medicines on the PBS, which are now not reaching the PBS.

I have met with numerous patient groups in my office in this place over the course of the past two years and have noticed that there has been a huge increase in both the number of these visits and the level of concern expressed about access to both new and existing medicines. Patients and their representative groups have lost confidence in the PBAC process, which I am concerned has been broken and is no longer based on process, transparency and genuine evidence-based medicine. The implications of this are enormous. The consequences for the nation's population and their health are frightening. Chronic age-related disease is consuming a greater and greater proportion of shrinking budgets for governments everywhere. Interventions and prevention policies alone are not working.

A rethink is sorely needed. There is and always will be a necessary place for pharmaco-intervention in chronic disease and we are failing at this hurdle. However, the ability to get new medicines through the PBAC process has been declining. The rate of positive recommendations for all PBAC submissions has almost halved from 84 per cent in March 2010 to a low 45 per cent in November 2012. The rate of positive recommendations for major cost-effectiveness submissions—these are where there is a claim of superiority over the comparator product and a request for a price premium for innovation—has fallen from 50 per cent in March 2010 to only 20 per cent in November 2012. On average, there was a mere 21 per cent positive recommendation rate in 2012, indicating a lack of willingness to pay for new innovative medicines requiring premiums over old medicines. Yet this is the very premise of the creation of innovation and the original intention of PBS reforms begun in 2007. These statistics are available on the department's own website at pbs.gov.au.

As further evidence of a complete disregard for the integrity and professionalism of the PBAC, three respected members of the committee who between them have given almost 20 years of service were quietly and unceremoniously let go from the committee earlier this year. This happened without any recognition being accorded to these members, and without any transparency and notification. The names of the three new appointees were not made public—even on the department's own website, as reported in PharmaDispatch earlier this week. This covert attempt to deny patients medicines which are now looked at by PBAC solely on the basis of cost rather than cost-benefit, and without reference to solid evidence-based medicine, exposes a fundamental flaw in what was once held out as a world-leading reimbursement system.

As a parliament, and without recrimination, we need to recognise that the PBAC has now become so politicised that the very basis of its original charter has been damaged and compromised. It is for this reason that, as a medical practitioner, I am proud that the coalition has pledged to restore transparency and certainty to the PBS listing process. This will return to a policy that is in the best interests of patients, doctors and carers. My colleague the shadow health minister, Peter Dutton, recently told the Sky Australian Agenda program:

One of the terrible things the government has done over the last couple of years is walk away from the independence of the Pharmaceutical Benefits Advisory Committee. So essentially they have made a political issue out of the listing of every drug. It has been a very bad precedent for the government to set and we will adhere to the independence of that authority.