Jonathon Duniam (Tasmania, Liberal Party, Shadow Minister for Environment, Fisheries and Forestry) Share this | Link to this | Hansard source

On behalf of Senator Ruston, who is unable to be with us today, I'll deliver a coalition contribution in relation to the National Health Amendment (Effect of Prosecution—Approved Pharmacist Corporations) Bill 2023. The opposition will be supporting this bill, as it provides greater protection for the Pharmaceutical Benefits Scheme from fraud and abuse, and we've always been strong supporters of the access to affordable medicines that the PBS provides to Australians and Australian households. We know that ensuring continued and improved access to affordable medicines is now more important than ever, with the cost of living continuing to put significant and rising pressure on Australians.

The National Health Amendment (Effect of Prosecution—Approved Pharmacist Corporations) Bill 2023 amends the National Health Act 1953 to support the sustainability and the operation of the PBS. The bill extends the discretionary power of the secretary and the Minister for Health and Aged Care to suspend or to revoke an approval for a pharmacist to supply pharmaceutical benefits at particular premises, irrespective of whether the approval is held by an individual or under a company structure, where they've been charged with a PBS related offence.

By way of background, where a pharmacist has been approved to supply pharmaceutical benefits at particular premises, the approved pharmacist can then make claims for payment from the Commonwealth in relation to the supply of pharmaceutical benefits, and the approval to supply pharmaceutical benefits can be held by a pharmacist as an individual or by a body corporate. However, the power to suspend or revoke an approval currently only applies to an approved pharmacist who is an individual. If a pharmacist operates under a company structure and they are charged with a PBS related offence, there is no ability for their approval to be suspended or to be revoked. This means, for example, that, if the director of an approved pharmacist corporation is charged with a PBS related offence, they can continue to receive payments from the Commonwealth—despite being charged for fraudulently claiming payments.

We understand the importance of the change contained in this bill, which will help to ensure the sustainability of the PBS by strengthening the compliance powers and ensuring that they are equally applicable to all types of approved pharmacists. This will better protect the PBS from further fraud and will provide greater deterrence to those who would seek to abuse the scheme.

The coalition has always been a strong supporter of the PBS, which ensures Australians have affordable access to critical medicines and will support this bill that protects the sustainability and integrity of this important scheme. We remain absolutely committed to supporting Australians to have access to affordable medicines when they need them most. We are proud of our strong track record in providing Australians with timely and affordable access to effective medicines, cancer treatments and services. When last in government, the coalition listed almost 3,000 new and amended medicines on the PBS, representing an average of around 30 listings per month. But we know that when Labor were last in government they had to stop listing the medicines on the PBS because they couldn't manage the money needed to fund these listings.

The government has stated that the measures contained in this bill support the integrity of public funds and ensure that they can be invested in access to new and improved medicines, and we will hold them to account on this. It's vital that they continue our strong track record on investing in improved access to affordable medicines for all Australians. However, we already hold concerns that this government is not prioritising investments in improved access to potentially life-saving or life-changing medicines, particularly following their decision to remove an innovative diabetes medicine, Fiasp, from the PBS. Now 15,000 families have had the rug pulled out from under them by this Labor government's decision to remove this life-changing diabetes insulin from the PBS, which will send the price soaring once it's off the scheme.

The former coalition government ensured that diabetes patients have affordable access to Fiasp by listing this fast-acting insulin on the PBS back in the year 2019. We understood that Fiasp is an innovative mealtime insulin that improves blood sugar, controlled at a faster rate than other diabetes medications, resulting in an improved quality of life for patients. We note Minister Butler's band-aid announcement to ensure diabetes patients have access to Fiasp for an additional six months if they are able to secure a script in time to cover them by 1 April. But the minister needs to be transparent with Australian diabetes patients and admit whether he has actually considered all possible steps to ensure Fiasp can remain permanently on the PBS, because we know Minister Butler has the power to come to a solution with the manufacturer, but sadly it appears he has not chosen to use that discretion.

The government needs to understand that this callous decision will tear away at the quality of life that this medicine affords over 15,000 people and their families across Australia. Labor went to the election with a promise to ensure cheaper medicines for all Australians, but this decision means that they've already broken that promise. For all their posturing on their promises, Labor shows time and again that their rhetoric in opposition is not matched by their actions in government. It is costing Australians' lives and livelihoods.

The decision to break their promise on affordable medicines comes on top of a growing list of broken promises from this government, including their promise to bring down power prices by $275, a promise made on 97 occasions. They also promised they wouldn't make changes to superannuation taxes, but one in 10 Australians will be affected by the changes they have now announced. It is clear that this is just the groundwork for more taxes and more changes to come. Labor promised to strengthen Medicare, but so far they have only weakened it. They slashed Medicare mental health support in half, they have cut 70 telehealth items from Medicare, and bulk billing rates have plummeted after being at their highest levels when the coalition was in government. Labor said they would make it easier to see a GP, but they have ripped GPs out of rural, regional and remote Australia by changing the distribution priority areas.

Labor promised cost-of-living relief, but the reality is life is only getting harder for Australians. Right now, to borrow a phrase from those opposite, everything is going up except for wages. Australians with a mortgage now buckle under the pressure of a 10th consecutive interest rate rise, which means a person with a typical mortgage of $750,000 is now paying $1,700 more per month than they were when rates started rising in May. Electricity prices are continuing to spiral out of control, with new increases of up to 23.7 per cent for households and 25.7 per cent for small businesses now announced. More than 100,000 small businesses will also be impacted by increased bills of up to $1,151 a year. It is these rising cost-of-living pressures on Australians, and indeed the cost of doing business in this country, that make access to affordable medicines so critical right now.

Once again, the coalition strongly supports this bill to support the sustainability and the operation of the PBS, which provides Australians with affordable access to potentially life-saving and life-changing medicines. However, we'll continue to ensure that we hold the Albanese Labor government to account on investing in and maintaining continued and improved access to affordable medicines, particularly in the midst of this cost-of-living crisis.

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

I speak on behalf of the Australian Greens in support of the National Health Amendment (Effect of Prosecution—Approved Pharmacist Corporations) Bill 2023. It really is an energising title that they've given to this piece of legislation! However, I want to use the opportunity to say to the Senate that the availability of medication on the Pharmaceutical Benefits Scheme has been insufficient for our community time and time again. On multiple occasions, in my role of health spokesperson for the Australian Greens, community groups have come to us and very clearly said that either they can't access the medications they need under the PBS or it just doesn't go far enough in providing the financial subsidy needed for them to access the medications affordably.

For instance, my office is contacted daily by people fighting to get access to insulin, to cancer medications, to basic medications that they need and rely on, quite frankly, to prevent their pain, to manage their symptoms and to provide them with effective treatment. I'm sure there are many people in the chamber this afternoon who live with medical conditions. It's really hard to manage these conditions as well as life with the meds that you need in order to manage them properly—let alone if you're managing the condition and managing life and are not able to access the meds because you can't afford them or they're not on the PBS in the first place.

The Greens have welcomed Minister Butler's announcement of a six-month access period to fast-track insulin medication Fiasp and also Fiasp FlexTouch to be part of the PBS, particularly for people who have type 1 diabetes. It's a step in the right direction. We have welcomed it. But it really is on the government to do a bit better in this space. I mean, we've got a situation where people's lives are at risk. They shouldn't need to share their story with the media to achieve and outcome. I'd imagine that many people here are quite used to that phenomenon, right? There's a situation where somebody needs medication urgently. They raise it with their local member. Maybe they raise it with their minister. Nothing happens, so they go to the media, a fuss is created and then eventually something occurs.

That's great community advocacy, and congratulations to the people for doing it. But I think we should just stop for a moment and consider whether that's actually how the system should work. Ministers are paid very well for their time and have very large staffs, working alongside massive departments. I think most people would assume that people become ministers and people work for departments and so on and so forth in order to, like, do a job, right? And that job surely should be proactively going out and finding the gaps before they have to be brought to the government's attention because somebody is in crisis. It is hard enough to be in the crisis, let alone to feel comfortable disclosing it to the media—going through the stresses and strains of that—in order to get your medication. And that solves just that one thing.

Ministers are applauded for doing this, for responding to individual case-by-case basis issues, but really, it speaks to the deeper systemic problem of what the job of a minister and the department is. What's the point? Surely it should be to do work on behalf of the people to proactively get ahead of these things. We need to see foresight in this space. We need to see medications coming onto the PBS in a way that ends this kind of perpetual catch-up that has to be played and this individual crisis-by-crisis based action.

The community need to be consulted sooner and better. If you go out there and talk to people, if you talk to patient advocacy organisations, they will tell you what needs to be added, because often these folks have gone to those organisations first to flag the concern. So there could be a bit of authentic engagement with patient advocacy groups, and maybe—this is a radical idea—you could engage with them in the same way as you would engage with very well cashed up, very influential organisations that might lobby you. You know, put the hat on and think: 'Well, this is a rare condition, this is a small cohort of people, it's a pricey drug, but if this was the AMA, maybe we'd pick up the phone. Maybe we'd sit down and have a conversation earlier because we know if those people got in the media we would have to deal with it.' I understand why these good, effective—I say 'good' in the sense that they have mastered the art of lobbying—organisations are responded to by government in the way that they are, but again, just because I understand it, just because there is a logic to it, it doesn't mean it is right. It doesn't mean that is how it should work. The reality is that as a member of the executive government to be lucky enough to do that and be that, you can actually chart your own course. You can actually decide that the small, often-ignored, peak body for a rare pain condition gets the spot in your diary that would be got by a larger, better funded, better known organisation. You can actually make that decision.

The Greens will always fight to reduce co-payments and ensure that the access to and affordability of medications on the PBS is something that is brought down on behalf of the community. In particular, as my second reading amendment addresses today, it is essential that First Nations people have access to medications that they require, when they require them, in order to meet our obligations. Let's hope we think of moral obligations in this sense, but there are also committed obligations under the Closing the Gap targets. Making sure that First Nations people have the opportunity to access their medications when they need them and where they need them is a key part of closing the gap.

One such step forward in this process was the Closing the Gap PBS Co-payment Program, which was established in 2010 to improve access to affordable PBS medicines for First Nations people who are living with or at risk of chronic disease. Yet public hospital pharmacists are currently unable to supply PBS medicines to First Nations people under the Closing the Gap PBS Co-payment Program, and this hampers quite seriously Australia's efforts to close the gap in healthcare outcomes for First Nations people. It means that doctors cannot supply medicine at the lower co-payment rate in hospitals, because they are excluded from the co-payment measure. It also prevents the provision of expert advice related to the new medication regime by pharmacists who have, basically, counselled them during a patient's in-patient stay. This results, at the end of the day, in inequitable, higher out-of-pocket costs and co-payments for First Nations people or situations in which the patients miss out on medicines altogether, increasing the risk of readmission to hospital. So we have a situation where the system, as it currently functions, increases the rate at which people are readmitted to hospital, precisely at the moment when we need to be freeing up capacity in our hospitals, particularly in rural and regional contexts.

My amendment asks the Senate to call on the Australian government to enable public hospital pharmacists to supply PBS medicines under the Closing the Gap co-payment program. Additionally, I note that the scope of the Closing the Gap PBS co-payment measure needs to be extended to cancer medications and highly specialised drugs listed on various Section 100 programs on the PBS, which are currently excluded from the program.

In addition to calling on the government to enable public hospital pharmacists to supply PBS medicines under the Closing the Gap co-payment program to First Nations people who are registered for the program, my amendment also seeks to ensure that this is done immediately. Time is a critical factor here to improve access and equity in relation to medications. This is in line with the call for national leadership from First Nations bodies in Australia, particularly the National Aboriginal Community Controlled Health Organisation and the Society of Hospital Pharmacists, who, in their recent budget submission, costed this measure at approximately $1.2 million. I have the great honour of being the foreign affairs spokesperson for the Australian Greens, and I work closely with my colleagues in the areas of defence as well. I've spent a long time in the defence and foreign affairs estimates hearings with Senator Shoebridge and others, and I can tell you now that our defence programs in Australia lose $1.2 million down the back of a couch before breakfast. So this is not a lot of money in the grand scheme of the Australian government, yet it would change lives.

I call on the Senate to support this amendment and for the Labor government to act immediately to ensure that these changes occur. I move:

At the end of the motion, add "but the Senate:

(a) notes that the Closing the Gap Pharmaceutical Benefits Scheme (PBS)Co-payment Program was established in July 2010 to improve access to affordable PBS medicines for First Nations people living with, or at risk of, chronic disease; and

(b) agrees that:

(i) poor access to medications can compromise a person's health and cause preventable hospital readmissions,

(ii) public hospital pharmacists are currently unable to supply PBS medicines to First Nations people under the Closing the Gap PBS Co-payment Program and this hampers Australia's efforts to close the gap in healthcare outcomes for First Nations peoples; and

(iii) the Australian Government should enable public hospital pharmacists to supply PBS medicines under the Closing the Gap PBS Co-payment Program to First Nations people, to improve equity of access to medications".

Paul Scarr (Queensland, Liberal Party) Share this | Link to this | Hansard source

Before I start my remarks in earnest, I'd like to note the point made by Senator Steele-John, which I thought was very well made, that Australians shouldn't have to resort to the media in order to gain traction with government decision-makers on issues around what medications are listed or not listed on the PBS. In our country, Australians shouldn't have to resort to the media in order to get these matters addressed, and I think that was a point that was very well made.

The National Health Amendment (Effect of Prosecution—Approved Pharmacist Corporations) Bill 2023 essentially addresses a loophole in relation to the application of penalties and remedial action taken in the case where a pharmacy has engaged in action which has been inappropriate and in breach of the PBS. The issue it addresses in particular is that you can have a situation where a pharmacy maybe has a licence and a corporate name but then has directors; a suspension action could be taken against those directors, but the pharmacy, under the corporate licence, is still operating, notwithstanding the fact that the director has been subject to some sort of penalty. This bill essentially addresses that loophole, which could allow a pharmacy to use the corporate veil to continue operating notwithstanding the fact that a director has done the wrong thing. In the first instance we should note that the vast, vast majority of our pharmacists do the right thing, and that this is an amendment which is seeking to address a small loophole. But it does give the opportunity for issues to be raised more generally in relation to the PBS, as Senator Steele-John and others, including Senator Duniam, have done.

I would like to take this opportunity to make a number of points. The first point is that the PBS and the cost-effective provision of medications to the Australian people is a core function of government. We should reflect on that because in this place, especially since the election, there's all sorts of legislation coming through where the government is looking to spend billions and billions of dollars of taxpayers' money on multifarious sorts of projects. For every single dollar that is spent on those projects, however well intentioned—whether it be the National Reconstruction Fund or whatever else it is—it is a dollar that can't go into our PBS system. There's an opportunity cost. I say it is a core function of government to provide medications and make medications free on a cost-effective, affordable basis to all Australians and especially to Australians who are suffering from diseases and conditions which require medications which are lifesaving. That is core business. So whenever the government comes into this place with one of those spending measures—and one of the next bills on the legislation list is the so-called National Reconstruction Fund, where the government is looking to invest $15 billion of taxpayers' money into various areas of economic activity—we should reflect that that is money that cannot be spent on core functions such as our health system. There is an opportunity cost. There is no magic pudding—there are no money trees around Canberra. It's all taxpayer dollars, and if they haven't got it in tax revenue they've got to borrow it and pay the interest on it. We should all reflect on that fact.

The second point I want to make is that the previous government—and I say this from opposition—can be duly proud of the number of drugs which were added to the PBS system under it. Three thousand drugs were added to the PBS list under the previous government. Thousands of Australians had their lives positively changed because of the medications added to the PBS system under the previous coalition government. Thousands of Australians had their lives changed for the better because of that. How did we do that? Through sound economic management. More than 30 drugs a month were added to the PBS system under the previous government. It changed people's lives for the better. That's what sound economic management does. That's what a government that is focused on the core functions of government can achieve.

In this context I'm obliged to raise an example of a situation which has happened under the existing government in relation to an insulin drug called Fiasp. I received a communication in my office before this last sitting from a resident in the western suburbs of Brisbane in relation to the fact that this drug, Fiasp insulin, was taken off the PBS without any warning. This is a drug that was on the PBS and people were using this drug—15,000 Australians were using this drug—in order to treat their diabetes condition. Then it was taken off the PBS without any warning. None. No warning. No consultation whatsoever. This resident wrote to me and said: 'I'm a type 1 insulin-dependent diabetic and have been for over 52 years now.' This could be your mother or your sister. 'This morning at 8.42 am I received a phone call from my chemist informing me that as of 1 April 2023 my insulin that I use in my pump will be withdrawn from the PBS listing. This being the case, my insulin purchase on script will go from $30 per filling of five boxes to approximately $220 for the same.' From $30 to $220! This lady, who could be your mother, your sister or your wife, got a call from her chemist who said, 'The cost of your medication to manage your condition, which you've been advised you should be on because of its particular characteristics: fast-acting'—

Marielle Smith (SA, Australian Labor Party) Share this | Link to this | Hansard source

Order! It being 1.30 pm, we need to move to two-minute statements.