David Pocock (ACT, Independent) Share this | Hansard source

I rise to speak in support of the National Health Amendment (General Co-payment) Bill. This bill provides welcome and needed cost-of-living relief to people who regularly use medicines. I would have liked to have seen the government extend the support to concessional payments, noting that prices of concessional medicines are about to increase in line with record inflation figures. I'll be moving a separate amendment on this bill during the Committee of the Whole stage but would like to speak to it now to save time.

Section 100 of the National Health Act allows the minister to make special arrangements for the supply of medicines. One such special arrangement is the Opiate Dependence Treatment Program, sometimes referred to as the ODTP. As it currently stands, this arrangement compels pharmacists to charge private dispensing fees for opiate-dependence treatments. Studies have shown these fees vary markedly across the country. While some pharmacies may charge as little as $1.50 per dose, some may charge up to $10. Therefore the average cost for a patient can exceed $1,800 per year. For some, it can be as high as $3,640 a year. It's worth remembering that for every other PBS medicine the government will pay the dispensing fee. Also, those dispensing fees are charged on a per prescription basis, whereas for opiate-dependence treatments they are charged on a per dose basis because of this special arrangement. The effect of this has been truly disappointing.

These fees provide a financial barrier for people looking to manage their addiction. It's no stretch to say that these fees are actually contributing to deaths that could be prevented. This was substantiated in a 2019 coronial inquest in New South Wales which found that it was 'alarmingly clear that many opioid deaths are genuinely preventable'. The New South Wales Coroner further recommended:

That urgent attention is given to improving the affordability of drugs substitution programs … for all drug addicted persons wanting to access them.

Three years on, and not much has been done. Three people likely died yesterday from an overdose, and, by the end of the day, another three people in Australia will likely die today. And this is all preventable.

In Australia, guaranteed access to safe and effective medicines is a much loved, well protected component of Medicare. Our Pharmaceutical Benefits Scheme provides financial protection to all Australians accessing any PBS medicine. Whether you're managing diabetes, a heart condition or reflux, you're guaranteed access to affordable medicines. Through the PBS, the government will subsidise the price of the medication if it's too expensive. The PBS also protects people who need lots of medicines throughout a year, through the PBS Safety Net. Once a person hits the safety net, they pay the concessional price for medicines or, if they're already paying concessional prices, then their medicines are provided for free. Once a person hits the safety net, they pay the concessional price for medicines or, if they're already paying concessional prices, their medicines are then provided for free.

Senators may be alarmed to find out that the protections of the PBS safety net have been removed for opioid dependence treatments through this special arrangement, despite them being PBS medicines. There's no rationale for this. People accessing opioid dependence treatments are also subject to cost-of-living pressures, including rising healthcare costs. It is bad policy at best and discrimination at worst to remove a nationally guaranteed protection for a group of people living with addiction disorder. The research is clear that these fees put people in a position where they have to choose between treatment and food. Some will skip meals to afford their treatment. Others will have no choice but to relapse or seek treatment in the already stretched public system.

It is important to remember that opioid deaths and hospitalisations are caused by prescription opioids. Some of these prescription opioids are on the PBS, and do count towards a patient's annual safety net. In that regard, the cost of the poison can be cheaper than their treatment. This special arrangement has baked in a financial disincentive for people to start treatment. This arrangement also negatively impacts community pharmacies. These are small businesses that have to make decisions to accrue debt in the interests of providing good health care, and that's exactly what they're doing across the country. In a survey of pharmacies in New South Wales and Victoria, over 70 per cent reported that they were providing credit—often bad credit—to patients who are unable to pay their dispensing fees. I applaud these pharmacies for making these compassionate decisions to help members of their communities. While it speaks to the integrity of our healthcare providers that they are willing to make these decisions, they shouldn't have to.

The parliament has not been given an opportunity to review the specific arrangement due to the way it was constituted. The arrangement has been set up under a non-legislative instrument. It has therefore never been considered by our Scrutiny of Delegated Legislation Committee or the Parliamentary Joint Committee on Human Rights. It has been set up to specifically put it out of the reach of the people in this chamber. I don't think that that is appropriate and it may not even be lawful. My amendment would make clear that all arrangements under section 100 must be legislative instruments by 1 July 2023. This has the effect of giving back to the Senate its oversight of these arrangements. It also puts a time line on actually having a reform to this existing instrument. If the current arrangement is not made a legislative instrument by this date, I am advised, it will cease.

I thank Minister Butler and his office for engaging with me on this important issue and for committing to reform. I understand there is a process to engage states and territories in this process and this may take some time. Nonetheless, in the interests of those struggling every day, I urge the government to do all they can to ensure that this is dealt with as quickly as possible. I thank senators for their consideration of this amendment.