Anne Ruston (SA, Liberal Party, Shadow Minister for Health and Aged Care) Share this | Link to this | Hansard source

The opposition is very pleased to support the National Health Amendment (General Co-payment) Bill 2022, because it enables the implementation of a key coalition election commitment—a commitment that the Labor Party was shamed into copying during the election campaign. The bill amends the National Health Act 1953 to reduce the Pharmaceutical Benefits Scheme general co-payment by $12.50, from $42.50 to $30, saving patients on out-of-pocket expenses. The opposition remains absolutely committed to ensuring that Australians have access to affordable medicines when they need them, and we support this legislation to reduce the costs of medicines because the coalition has always been committed to ensuring that Australians can access essential and lifesaving medicines at an affordable price. The coalition has a strong record of delivering affordable, life-saving medicines for all Australians. We encourage this government to continue our policy of listing all medicines on the PBS that are recommended by the Pharmaceutical Benefits Advisory Council.

The bill amends the PBS general co-payment from the current amount of $42.50 to a new amount of $30, taking effect as of 1 January 2023. For certain medicines or treatments that have a Commonwealth price between $30 and $42.50—which are indexed annually—the bill gives pharmacists an option to discount that price to general patients by more than $1 while supplying it as a PBS script. This ensures that no patient is worse off after the reduction of the general patient charge, given the established practice of pharmacists to be able to discount medicines that have a Commonwealth price at or below the current general patient charge. The bill gives effect to an election commitment made by Labor in response to the coalition's clear leadership on this issue.

On 30 April 2022 the coalition announced an election commitment to reduce the PBS general patient charge by $10 as part of an annual $150 million hip pocket saving for Australians. We planned to wind the clock back on the cost of medications, reducing the cost per script back to 2008 prices. Following this announcement, on the very next day, Labor announced that they would reduce the general co-payment by an additional $2.50.

I also note that in the budget last night Labor continued their longstanding commitment to copying coalition policies by listing medicines on the PBS that we had already announced were going to be listed. We had provisioned for skin cancer patients to get PBS access to Libtayo, which will benefit around a thousand patients with metastatic or locally advanced cutaneous squamous cell carcinoma each year. Without this subsidy patients face costs of more than $144,000 for a single course of treatment. We had also provisioned for the 1,450 patients with advanced and metastatic gastro-oesophageal cancers to benefit from the listing extension of Opdivo on the PBS, saving these patients over $92,000 per course of treatment.

Another copycat initiative of this new government is trying to claim credit for its funding of support for an additional 71,000 people who live with type 1 diabetes, enabling them to get access to subsidised continuous glucose monitoring—an initiative that was announced by the coalition government earlier this year. I welcome the government's decision to support these measures, and their recognition that the coalition is a policy leader when it comes to affordable medicines and supporting Australians who rely on them. We are pleased that we were able to lead the government into making commitments in this important policy area to support the hip pockets of Australians who rely on essential medicines and treatments.

The coalition has a strong track record of providing Australians with timely, affordable access to effective medicines, treatments and services. When we were in government we listed more than 2,800 new or amended medicines on the PBS, representing an average of around 30 new listings per month. Most recently, from 1 April 2022, our strong economic plan meant that we were able to ensure that patients suffering from severe heart failure, high cholesterol and high blood pressure could afford cheaper medicines to treat their conditions. We were also able to list life-saving drugs to support Australians with asthma, prostate cancer, Castleman disease, HIV and Crohn's disease. This included the PBS listing of Trelegy Ellipta 200, which was funded by our government to be expanded for Australians with severe asthma. Asthma is a common chronic condition and can become serious, especially if untreated. Without the PBS subsidy over a thousand Australians may have paid more than a thousand dollars per year for treatment.

Another integral listing supported by the former coalition government was an oral treatment that has shown improved survival outcomes for patients with prostate cancer who have specific gene variants. Prostate cancer is the second-most common cancer diagnosed in men in Australia and the most common cause of cancer death, with one in six men estimated to be diagnosed with prostate cancer by the age of 85.

We did not plan to stop there. In the coalition's 22-23 budget we provisioned $2.4 billion for more new and amended PBS listings. These listings also included critical treatments for breast cancer, cystic fibrosis, severe asthma, spinal muscular atrophy, HIV infection and heart failure. By listing medications on the PBS, we ensured that Australians have access to affordable, life-saving medications that, without a subsidy, would otherwise cost thousands of dollars, or even hundreds of thousands of dollars.

It is disappointing that Labor had stopped listing medicines on the PBS when they were last in government in 2011 because they couldn't manage money. Australians requiring medicines to treat severe asthma, chronic pain, schizophrenia, blood clots, IVF, endometriosis and prostate conditions were all impacted by Labor's inability to afford important investments in the PBS. In announcing this legislation, the Albanese government highlighted the reduction in the copayment as a cost-of-living relief measure to address the significant pressures facing Australians right now right across the country. Although the opposition supports reducing the cost of medicines to provide relief directly to the hip pockets of Australians, it is important to note this is one of the very few cost-saving relief measures the Albanese government has announced in its budget so far and it also does not take effect until 2023.

We on this side support Labor's bill to reduce the general copayment for medicines on the PBS; however, we hope that they do not consider their job done on supporting Australian families with the rising cost of living by this one initiative. The opposition has significant concerns that the Albanese government could fall back into their old pattern of having to stop making critical investments into essential supports for Australians and we will hold the government to account so they do not repeat the disaster of their poor economic management in their last term in government that saw important medicines stop being listed. I commend this bill to the Senate.

Jordon Steele-John (WA, Australian Greens) Share this | Link to this | Hansard source

The Australian Greens will be supporting this bill to reduce the general copayment of PBS items from $42 50 down to $30. We know in doing this that this is in fact the bare minimum that this government could be doing to improve access to medical supports that members of our community need at the moment. I hear from many members of our community, particularly from young people, that when they seek support, particularly mental health support, they are confronted with a system that either does not have the capacity to see them in a timely manner or simply costs too much.

Members of our community need access to affordable and accessible Medicare services like never before. They need their dental care to be covered under Medicare. They need their mental health supports to be covered. They need their GP to be affordable and to be well trained. Tax cuts for billionaires, like those which were provided in the budget last night during a time when people can't afford to see the dentist, to go to a doctor, to access mental health supports when they need them, is a completely unjustifiable move by this Labor government.

I will flag in this contribution that the Greens will be supporting the amendments offered by Senator Pocock. The amendments to this bill offered by the senator relate to section 100 to ensure that decisions made under the section 100 powers are always created as legislative instruments, allowing them to be scrutinised and to be disallowed, ultimately, should the Senate see fit. I have actively questioned the health department at Senate estimates about the section 100 programs under the National Health Act, particularly in relation to the opioid dependency treatment program. Opioid dependency is a complex health condition that requires long-term support and long-term care. Such treatment programs for opioid dependency make a real impact on people's lives. I will say that again: programs like the opioid dependency treatment program make real impacts on people's lives. These are real programs that shape people's lives every single day and this particular program, as constituted and enabled under the section 100 provisions, has come into being and been enforced through an instrument that is not subject to the scrutiny of this parliament. Scrutiny in these issues is so vitally important because it acts as a counterbalance on government, particularly when government thinks that it can get away with mistreating people—when it thinks it can get away with placing burdens upon communities because those communities are subject to stigma. And that is very much the case with those who access this particular program.

I'll say this again very clearly: the National Health Amendment (General Co-payment) Bill is the bare minimum that the Australian community needs. Let's get the Australian community the health care that they actually deserve. Let's get dental care into Medicare. Let's get mental health into Medicare. Let this Senate proclaim the radical proposition that the teeth and the brain are part of the body! The Greens will continue to make this logical case for the expansion of Medicare and to work with our community to drive out stigma and barriers, where they exist, and to work to reshape the system in line with community need.

David Pocock (ACT, Independent) Share this | Link to 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.

Murray Watt (Queensland, Australian Labor Party, Minister for Agriculture, Fisheries and Forestry) Share this | Link to this | Hansard source

Over the last two days, the House of Representatives has debated legislation to introduce the biggest cut to the cost of medicines for Australian households in the 75-year history of the Pharmaceutical Benefits Scheme—a cut in price for general patients of almost 30 per cent to the maximum cost of their scripts from $42.50 to just $30.

It was a Labor government that first introduced legislation to make life-saving drugs more affordable, and the Albanese government now remains committed to ensuring that the PBS continues to enable Australians to access affordable medicines. After almost a decade of neglect by the Liberal and National parties, the costs of living are soaring with many Australians cutting back on essentials to make ends meet. They are being forced to choose between filling prescriptions for potentially life-saving medicines and providing for their families. This bill amends the National Health Act 1953 to reduce the maximum general patient co-payment under the PBS from the current maximum of $42.50 to $30. From 1 January 2023 around 3.6 million Australians with current prescriptions over $30 will benefit through this initiative of the Albanese Labor government. People filling a prescription for one medication per month will save around $150 a year, while a family filling prescriptions for two or three medications per month could save $300 to $450 per year.

The bill will ease the cost-of-living pressures that Australian households are experiencing around the country, but this bill will also have a profound benefit to public health. We know from the Bureau of Statistics that every year as many as 900,000 Australians go without the medicines that their doctors have said are important for their health simply because they cannot afford them. There is no doubt that all Australians place great value on the medicines and essential health care the PBS provides. All Australians deserve access to universal, prompt and world-class medical care. Pharmacist after pharmacist has told stories of their customers coming into their pharmacy, putting a number of scripts on their counter and asking for advice about which ones they can go without because they can't afford to fill all of the scripts that their doctor has said are important for their health.

We know this policy will make a difference because of what Australians are telling us. Cherie from Bribie Island, in my home state of Queensland, says that after buying medications she must also pay for groceries and rent. Every dollar adds up, and she doesn't want to have to choose. She knows this change will make a big difference for her and her friends. Grace, a 20-year-old type 1 diabetic who has just moved out of home, told the health minister, Mark Butler, 'I am so thankful that insulin will be cheaper for me now that I live out of home.' Cornelia said: 'This will make such a difference to us. My husband is on about a dozen scripts a month to keep him well enough to keep on working. He's been able to work in a physical job thanks to great specialists, GPs, pharmacists and especially research staff, and thanks to the PBS we can just about afford all of these drugs. Any further discounts will help enormously.'

This bill will ensure patients receive the essential medical care needed to prevent serious illness and stay healthy. It will allow Australians to shop around to get the best price for their medicine. The bill will ensure that no Australian will be worse off under this change by including provisions to allow pharmacies to continue offering discounts at current levels to their customers. Right now Australians are paying the price for a decade of missed opportunities and drift. Through this bill we'll make a real difference to household budgets for millions of families but also to people's health. After nine years of neglect from the former government, the costs of living are soaring and Australians are cutting back on essentials to make ends meet.

The maximum cost to general patients for PBS medications has doubled since 2000, and the previous government did nothing to help. The Liberals and Nationals, when they were in power, committed to cutting the costs of medicines, but only the Albanese Labor government committed to cutting the general patient maximum co-contribution from $42.50 to just $30. Cutting the maximum price by nearly one-third will mean more people can afford to get the medications they need to stay healthy. This change will put close to $200 million back into the pockets of Australians each year. Just like Medicare, it was Labor that built the PBS and Labor will always protect it so that all Australians can access affordable medicines when they need them. I thank all senators for their contributions and commend the bill to the Senate.

Question agreed to.

Bill read a second time.