Emma McBride (Dobell, Australian Labor Party, Shadow Assistant Minister for Mental Health) Share this | Link to this | Hansard source

I move:

That this House:

(1) notes that the:

(a) Pharmaceutical Benefits Scheme (PBS) has assisted generations of Australians to access affordable medicines since its inception by the Chifley Government in 1948; and

(b) longstanding practice of successive governments has been to accept and act on the advice of the independent experts—the Pharmaceutical Benefits Advisory Committee (PBAC)—when listing medicines on the PBS;

(2) acknowledges that the Department of Health revealed at Senate estimates hearings that there are more than 20 drugs that this Government will never list on the PBS because pricing negotiations with their manufacturers have broken down;

(3) recognises that there are increasing barriers to Australians accessing affordable medicines, including:

(a) the failure to act on a number of PBAC recommendations;

(b) the affordability of PBS co-payments; and

(c )increasing out of pocket costs to access primary and specialist health care; and

(4) condemns the Government for failing to recognise and address these barriers and calls on the Government to do so as a matter of urgency.

A division having been called in the House of Representatives—

Sitting suspended from 18:35 to 18:45

I move this motion because as a pharmacist, the only pharmacist in this place, I am dismayed by the Minister for Health's shameless politicisation of the Pharmaceutical Benefits Scheme by spruiking the listing of new drugs and then claiming the credit. It occurred again this weekend with the long overdue listing of Symdeko, seven months after it was approved. As Niki Savva points out in Plots and Prayers: 'Previous health ministers would release the names of listed drugs en masse during the working week with little fanfare, receiving little or no publicity. Hunt knew how to get attention.'

It is my view that a PBS listing—that is, the subsidising of a medicine—should not be turned into a political stunt or self-promotion event. Listings are in the interest of public health and they matter. They should not be reduced to a photo opportunity for a political agenda. It is worth noting that the minister's public 'announcements' don't deliver a single clinical outcome. These are delivered by the hardworking research scientists, by industry and by clinicians. Other health ministers haven't engaged in this sort of fanfare.

Early in my career, new medicines were routinely listed on the PBS at set intervals. One of my jobs was to make sure the floppy disk had been installed and the PBS updates had been applied in the community pharmacy where I worked. That was it. But if the minister must take credit for each new listing he must also take responsibility for the growing delays and failure to list medications which have been recommended by the independent experts, the Pharmaceutical Benefits Advisory Committee. Labor's record on the PBS, unlike that of those opposite, is rock solid. From its introduction by the Chifley government in 1948 in the face of strong opposition, including a High Court challenge, through to the first safety nets of the Hawke Government in 1986, it is something that we on this side of the chamber can be proud of.

When I gave notice of this motion in early September we were aware of some 20 medications that had not been listed, despite having been recommended by the PBAC. Since then the PBAC has made public its recommendations from the July meeting, which took the total number of drugs waiting to be listed by Minister Hunt to almost 60. These are drugs that have been recommended for listing by the independent experts, the Pharmaceutical Benefits Advisory Committee, because they stack up on both clinical and cost grounds. Australians who are sick deserve to have a medication which has been approved by the PBAC listed as soon as possible. But this just isn't happening. At the same time the Government's recent budget updates showed a $155 million underspend on the PBS.

The minister's failure to act on PBAC recommendations to list medications in a timely manner or to list them at all is not the only barrier to Australians accessing affordable medicines. The government's own figures show that many Australians don't fill prescriptions because they just can't afford them. According to the Australian Bureau of Statistics, 961,000 people a year delay or avoid taking prescribed medicines due to cost. The rate of people skipping prescriptions is twice as high in the most disadvantaged areas as it is in the least disadvantaged areas, meaning that the cost of medicines is contributing to health inequality in Australia today—and that's assuming that you can see a doctor to get a prescription.

New Medicare figures confirm what Australians already know, that the out-of-pocket cost to see a doctor is higher than ever before. The government's own data shows that the average out-of-pocket cost to see a GP is $39.55, up $10.40 or 36 per cent since the Liberals were elected. The same is true for the cost of seeing a specialist. The average out-of-pocket cost to see a specialist is now $91.50, up a staggering $33.40 or 58 per cent since the Liberals were elected. These costs are pushing household budgets to breaking point. The Australian Institute of Health and Welfare—the government's own experts—say that 1.3 million Australians a year delay or avoid Medicare services due to cost. That's just not good enough. It's worth repeating: in a country that prides itself on universal access to health care, over a million people every year can't afford basic essential health care. The minister has repeatedly promised that if a medicine is recommended for listing by the experts, that if a medicine is recommended by the Pharmaceutical Benefits Advisory Committee, that he will list it. That is just not true, and it's not good enough. The minister can't spruik drug listings and claim the credit for them. It's not okay.

Sharon Claydon (Newcastle, Australian Labor Party) Share this | Link to this | Hansard source

Is the motion seconded?

Peta Murphy (Dunkley, Australian Labor Party) Share this | Link to this | Hansard source

I second the motion and reserve my right to speak.

John Alexander (Bennelong, Liberal Party) Share this | Link to this | Hansard source

Thank you to the member for Dobell for bringing forward this important debate. I have mentioned before about Bennelong being the capital of innovation. We have some of the most cutting edge companies in the world. We've invented things that make your life better, from wi-fi to the Granny Smith apple. One of the biggest drivers of this innovation is the pharmaceutical companies. Most of them are based in Macquarie Park in Bennelong, so many that it is commonly referred to as 'Pill Hill'. From these, over a dozen companies, come many of the drugs that are listed annually and are saving lives daily, thanks to the PBS. The PBAC considers and recommends medicines for listing on the PBS three times a year, and critically this government has a policy to list all positive recommendations on the PBS.

From October 2013 to 1 September 2019, 2,185 new or amended items have been listed on the PBS. In 2012-13, the average was 321 days from PBAC recommendation to approval. But, last year, this was down to an average of 189 days. Obviously we can still get these numbers down further, but I think it's important to recognise the efforts that have already been made in this area and government's efforts to make this better for companies and, more importantly, for their patients.

Just this weekend Minister Hunt announced that patients can gain access to Symdeko and Orkambi immediately, with the manufacturer agreeing to the government's request to provide early access until the medicine is listed on the PBS on 1 December. This is expected to provide new or improved treatment options for over 1,400 patients. People might otherwise have to pay up to $250,000 a year for Symdeko or Orkambi. These two are amongst the 32 new and amended listings made by the government per month, approximately one per day. This is at an overall cost of around $10.6 billion.

Amongst these dozens of listings are a number of local 'Pill Hill' contributions. These include Apotex, which received a listing for flucloxacillin for treatment of serious staphylococcal infection and osteomyelitis. In 2018, more than 525,000 patients accessed a previously available brand of antibiotic for this condition and may now benefit from this new listing. And memorably, back on 1 June 2018, the government committed to $241.3 million for Spinraza, made by a local company Biogen. This is a life changing medicine that treats the devastating illness of spinal muscular atrophy. Without subsidy, patients would pay more than $367,000 per year.

Additionally, since October 2013, the government has approved more than 100 new and amended listings for cancer on the PBS at an expected cost of more than $6.6 billion over the forward estimates. Local contributions to the cancer space include some really exciting innovations. MSD's Keytruda is an immunotherapy that could change the game for cancer treatment. It has already been listed for patients with local or advanced metastatic urothelial cancer, saving 430 patients over $91,000 per course of treatment, and many more will benefit as its listings grow. A newcomer to Bennelong, Merck, has had Bavencio listed, at a cost of over $81 million, for the treatment of metastatic Merkel cell carcinoma, a rare and highly aggressive type of skin cancer. This will save 160 patients close to $150,000 a year. In 2019 under the PBS patients will pay a maximum of $40.30 per script, with concessional patients, including pensioners, paying just $6.50.

The Australian government is continuing to meet its commitment to invest in new medicines on the Pharmaceutical Benefits Scheme. The government will list all medicines that are recommended by the Pharmaceutical Benefits Advisory Committee. The industry has seen some tough legislative times in recent years, but thanks to an agreement signed by Medicines Australia and the dedication of our current excellent health minister, the future is looking bright for patients who need to access cutting-edge medicines. (Time expired)

Peta Murphy (Dunkley, Australian Labor Party) Share this | Link to this | Hansard source

I rise to support this important motion put forward by my colleague the member for Dobell about affordable access to medicines when Australians need them. I want to adopt what my colleague, the only pharmacist in this place, said—that access to affordable medicines and health care shouldn't be a political stunt. It's above politics because it's about egalitarian access to health care, universal health care. It's really one of the great manifestations of one of the most fundamental of Australian values—fairness. It's something that we in this country are rightly proud of, and it's something that we have to hold precious and hold dear and fight to protect. The promise of universal health care is the promise of an egalitarian society—a society where, no matter how much money you have in the bank, how much money you earn, or even if you don't earn any money at all, if you are sick, you know that you'll have access to the best medical care, including the best medicines. When you're sick, the last thing you need to be worried about is how you're going to be able to afford to go to the doctor, to see the specialist, or to buy the medicine, which in many cases is life-saving.

Since 1948, the Pharmaceutical Benefits Scheme, proudly introduced by a Labor government, has been one of the most important elements of Australia's universal healthcare system, along with that other great Labor reform, the Medicare system. We know that the aims of the PBS, the Pharmaceutical Benefits Scheme, are to ensure timely access to medicines that Australians need at a cost the individual and the community can afford, and also to make sure that medicines meet appropriate standards of quality, safety and efficacy. It is really important that the Pharmaceutical Benefits Scheme and the work of PBAC, the Pharmaceutical Benefits Advisory Committee, are not politicised, are not used as a weapon against the other side, and they're allowed to go about doing their job; and when PBAC says, 'These medicines should be put on the PBS,' then that's what happens. As the member for Dobell said, if the health minister wishes to claim credit for every drug that is put on the PBS, then he has to accept responsibility for the fact that there are 60 drugs which have been recommended by PBAC to put on the PBS which are not there—not only drugs that would improve the quality of life for many Australians who need it but drugs that in many cases would prolong and save Australians' lives.

There are also drugs that the Australian government needs to put on other schemes. One of them is flash continuous glucose monitoring. Despite the shadow minister for health tabling a petition of some 214,000 signatures requesting the Minister for Health to list the flash glucose monitor on the NDSS as soon as possible, it is not on the NDSS. That means that people like my constituent Jacqui can't afford to pay for it. Jacqui is very lucky that she's been put on a trial of FreeStyle Libre with Frankston Hospital. She came in to see me and told me how flash continuous glucose monitoring has changed her life as a diabetic. It has allowed her to undergo daily activities that most of us take for granted and to monitor her health and wellbeing. She came to see me and said: 'Peta, I'm not just here for myself. In fact, I'm predominantly not here for myself. I'm here for all the other diabetics who are out there whose lives have been a constant battle just to have stability. I want them to have access to whatever they need so that they can be a contributing member of society and can feel that they're a contributing member of society.' I join those 214,000 Australians and the shadow minister for health and call on Minister Hunt to get flash glucose monitoring on the NDSS as soon as possible.

We know that out-of-pocket costs for health care have gone up and up. We have Australians living with flat and stagnant wages, with rising household expenses and rising out-of-pocket costs for health care. We know that those who are the most disadvantaged, those who are struggling the hardest to get by, are the ones who are going without when it comes to health care. That is not good enough. That is undermining the promise of universal health care, and, like every other member of the Labor caucus in this federal parliament, I will stand up as often as I can to say we must fight for it and not let it be undermined.

David Gillespie (Lyne, National Party) Share this | Link to this | Hansard source

I'm very proud to be talking on the Pharmaceutical Benefits Scheme. Everyone in this room recognises that it is a wonderful system that was brought in by none other than Ben Chifley, as the member for Macarthur has pointed out. No-one disputes that; it is a great system. And, since 2013, it has gone ahead in leaps and bounds. I'll just outline some of the things that have been achieved, and then I'll correct the record on some of the distortions of fact that are appearing on the other side.

First of all, we have listed 2,100—in fact, there are now 2,102—items on the Pharmaceutical Benefits Scheme since we were given the responsibility of running government in 2013. That's an exceptional golden period of new drugs. The latest ones that were listed on the weekend were for cystic fibrosis, the dual listing of Symdeko and Orkambi. I don't know of any other jurisdiction that subsidises the cost of these wonderful, life-changing drugs for people who are born with cystic fibrosis. We've also lowered the age at which it becomes available, down to the age of two. Previously, you could only access one of these drugs once you were over the age of five.

For lung cancer—one of the commonest and probably the most fatal of the solid organ cancers—we've got Keytruda, Tecentriq and Avastin. Now for those last two, it's $189,000 for a course. For Keytruda, it's $90,000 for a course. We've added treatment for acute lymphoblastic leukaemia, Sprycel; there are new drugs for ovarian cancer, for heart disease, for asthma, and the list goes on and on and on.

Now, clause (2) of this motion refers to the government not listing 20 drugs. I have checked with the minister's office, and he has in turn checked with the department. The department is not a political animal; it's a deliverer of the great health system that we have. There are no—I'll just get the exact words, so I'm not misquoting. The department says, 'The PBS schedule will shortly be updated to reflect a number of additional medicines that will be listed on the PBS on 1 November.' What they are referring to is the PBAC. It makes it's recommendations; it does that three times a year. There is a delay between when it recommends it and—there's correspondence sent to the makers of these drugs. There was recently a nine-month delay for one drug before the overseas company agreed to the listing conditions; it took nine days from that letter being received to these last couple of drugs being listed. So it's a pretty quick system.

It's in the budget papers and it's on the public record, but there can be delays. In 2011 the then Labor health minister, Nicola Roxon—I give her marks for being honest—said:

Ultimately I think the important point is that we can't in every instance guarantee that a drug will be listed immediately because there are financial consequences for doing that …

As a result, for some of the drugs that had been recommended, there was a willing seller, but there just wasn't money in the budget. That was for severe asthma; COPD, a chronic obstructive pulmonary disease; endometriosis; IVF treatment; and some schizophrenia drugs.

We have a very proud record of delivering for the people of Australia. You do have to manage your budget, because we have high-cost medication listings across the board. They do cost a lot of money, but those cystic fibrosis drugs will actually add, on average, 20 extra years of life to people who are born now and who start these wonderful drugs, which improve their lung function, at an early age. All the thick mucus damages their lungs and their pancreas and affects their bowel. All that will be limited. They will be better nourished. Their lungs will work. They will have a much better outcome.

We should be celebrating the wonderful system that we have in this country. We have managed our budgetary pressures well. We are listing. At the moment, all the ones that have been recommended and the companies we've responded to have been listed, which is a pretty amazing outcome. What a turnaround since 2013.

Mike Freelander (Macarthur, Australian Labor Party) Share this | Link to this | Hansard source

One thing I will not do tonight is politicise the argument about the Pharmaceutical Benefits Scheme. The history is well known to everyone in this place. I think it is absolutely disgraceful that the present health minister is politicising what for 70 years has been a bipartisan scheme, and I will not do that. I've been very pleased to speak on the motion moved by my good friend the member of Dobell. She is someone who has worked as a hospital pharmacist for many years. I'd like to thank the member for bringing this important matter before the chamber and I associate myself with her words.

I'd also like to thank my friends from the other side of parliament, the member for Bennelong and the member for Lyne, for speaking on this motion, together with the other speakers. In the motion, the member of Dobell has hit the nail on the head. It has been the longstanding practice of successive governments to accept and act on the advice of independent experts—the Pharmaceutical Benefits Advisory Committee—when listing medicines on the PBS. If we don't do that, we end up having an arms race of lobbyists who lobby for these respective medications. That is something that we must not do. It also leads us to an exploitative manipulation of our patients. As a doctor, one who has prescribed medications listed on the PBS for now over 40 years, I think that that is the last thing we should be doing. I think it's a great shame that the current health minister has attempted to do this. What we need are evidence based ways of prescribing medications, and that's what the PBAC does with the PBS.

In contrast to what the member for Lyne has said, we don't really know what the long-term benefits of some of these newer listings will be. It appears in the short term that medications such as Kalydeco and Symdeko for children with cystic fibrosis will extend their lives, but there is not enough accumulated evidence to really know that in the longer term. We rely on short-term evidence and the advice of experts to decide whether we should list these drugs. Cystic fibrosis is a dreadful, horrible disease, and any parent who has a child with cystic fibrosis knows what they have to go through. Certainly, at the present time, life expectancy is relatively short, although it is much better than when I started as a paediatric resident in the children's hospital in 1979. We hope that these newer medications will improve lifestyles and life length in the long term, but we really don't know the exact ways and the exact end point. That's why we rely on the advice of experts.

Over recent years, we also have become accustomed to seeing this health minister grandstand and congratulate himself each and every time the government follows the independent advice of the Pharmaceutical Benefits Advisory Committee, and I think that's a great shame. The PBS has enjoyed bipartisan support since it began in 1948. As has already been mentioned, it was started by the Chifley Labor government. As a doctor, I cannot underestimate the significance that the PBS has had on our society since its inception in assisting Australians to access affordable medicines. I want that to continue, and I want it to continue in a bipartisan way. We're now being faced with an absolute tsunami of new medications and new treatments. That will ramp up with the development of the new biologic and genetically targeted medications. I think that KEYTRUDA has already been listed as one, but there are many thousands that will need to be looked at and decisions made about their listing in the next few years. That number is increasing every day, even as I speak.

We need to have a bipartisan, fair and equitable way of deciding which medications to list and which we don't. The health minister sometimes delays listing because of cost pressures. Recently, there was the example of a treatment which was a multipronged catheter for use in a condition called atrial fibrillation. I know—and the minister told me—that they would delay the listing because of the cost pressures. So to get up there and say that because their budget is going so well et cetera is why they list things is rubbish. We act on independent advice, we act on advice that is given to the minister and to the PBS, and that's how it should stay. We should stop exploiting patients.

Nicolle Flint (Boothby, Liberal Party) Share this | Link to this | Hansard source

I am pleased to speak on this motion today, because it gives me the opportunity to highlight some of the fantastic work our government is doing in this area.

The Morrison Liberal government has a strong record of delivering more medicines through the Pharmaceutical Benefits Scheme and making those medicines more accessible and more affordable for Australians. We are listing all medicines that are recommended by the Pharmaceutical Benefits Advisory Committee on the PBS as a matter of policy. Since 2013, our policy has resulted in approximately 2,200 new or amended medical listings on the PBS, valued at around $10.6 billion. This is an average of around 30 new or amended listings per month, or approximately one per day.

Just yesterday, the health minister announced the addition of cystic fibrosis medicine SYMDEKO for patients over the age of 12 with specific gene mutations. The minister also announced that the listing for the medicine ORKAMBI would be expanded for children between the ages of two and five years old. This is expected to provide new or improved treatment options for over 1,400 people who might otherwise pay up to $250,000 a year. We are also helping 3,000 women with breast cancer by subsidising the medicine KISQALI, which, without subsidy, can cost more than $71,000 per year. We are also subsidising SPINRAZA for Australian children with spinal muscular atrophy, which would otherwise cost these families more than $367,000 a year. Clearly, that is completely out of reach for pretty much every single Australian. The cost of accessing these medicines without subsidy would just be completely prohibitive for these individuals and for these families.

Make no mistake: these listings make a life-changing difference to these people who need the medicines, to their families and to their friends. That's why our government is committed to continuing our strong record of making more medicines available to more people. In order to do this, we are lowering the PBS safety net threshold amounts for concessional and general patients and their families from 1 January 2020. This will benefit up to around 1.6 million concessional patients and 129,000 general patients, allowing them to reach the PBS safety net sooner and reducing their out-of-pocket costs. We can do all of this because of our government's strong economic management. When we have a strong economy we can afford to invest in essential services like hospitals, like Medicare and like the PBS.

We don't have to look back too far, unfortunately, to understand the impact of poor economic management on delivering medicines to those who need them. Last time the Labor government, those opposite, were in government they reversed the policy of the coalition to list all medicines approved by the independent Pharmaceutical Benefits Advisory Committee, because they couldn't manage the economy. On 25 February 2011, Labor announced the unprecedented deferral of the listing of seven medicines under the PBS for conditions such as severe asthma, chronic obstructive pulmonary disease, endometriosis, IVF treatment and schizophrenia. In 2011, Labor's then health minister, Nicola Roxon, said:

Ultimately I think the important point is that we can't in every instance guarantee that a drug will be listed immediately because there are financial consequences for doing that …

In other words, due to their own financial mismanagement Labor stopped listing medicines approved by the PBAC in an attempt to cut costs.

This motion is yet another attempt by Labor to play politics with an issue of critical importance to so many Australians, but it does, however, give me an opportunity to remind those opposite of some facts about the process for the addition of medicines to the PBS for the benefit of so many Australians. By law, the government cannot list a medicine on the PBS unless it has been recommended by the Pharmaceutical Benefits Advisory Committee. The PBAC meet three times per year to consider and recommend medicines for listing on the PBS. The time it takes for a medicine to be listed following a PBAC recommendation is usually determined by the approach of the sponsoring pharmaceutical company.

I will finish by saying that the PBS needs a responsible government managing a strong economy, and that is exactly what the Liberal Morrison government is delivering.

Kevin Hogan (Page, National Party) Share this | Link to this | Hansard source

The time allotted for this debate has expired. The debate is adjourned and the resumption of the debate will be made an order of the day for the next sitting.