The Consumers Health Forum replies below to my recent Croakey post on changes to the Pharmaceutical Benefits Scheme (PBS) and access to new medicines…

Carol Bennett, Chief Executive Officer of the Consumers Health Forum, writes:

In her comment piece “Restricting access to new medicines: beyond the outrage” (Croakey, April 29), Melissa Sweet, paraphrasing Health Minister Nicola Roxon, says: “the government must weigh up competing demands for public spending….”

As the peak consumer health organisation in Australia, the Consumers Health Forum (CHF) does not dispute this.  But, as noted in one of the comments below the story, this is exactly what the world-renowned Pharmaceutical Benefits Advisory Committee (PBAC) does and has been doing since it was created as an independent statutory body in 1954.

As Lesley Russell from the Menzies Centre for Health Policy pointed out in the Australian Financial Review (24 April 2011), the Pharmaceutical Benefits Scheme (PBS) approval process is “probably the most robust evidence based process that any government spending must go through”.

A testament to this is that, as far as is publically known, there have been only two occasions in that time – the proposed listing of Viagra and nicotine patches  – when Federal Cabinet has intervened to reject a PBAC recommendation outright.  And, whenever there has been any political interference with the PBS listing process, there has been community outrage, for good reason.

Certainly, Cabinet has always had the authority to reject individual recommendations and in 2001 it was announced that Cabinet would consider products that cost more than $10 million in any of the first four financial years of being listed on the PBS.

It is because the PBS listing process is so rigorous and effective, that what Ken Harvey describes as “an unholy alliance” between consumers, health professional and industry peaks has emerged to defend it and to question the clear politicisation of a process that has served Australia well for over 50 years.  It’s hard to imagine how the Government could so effectively unite these groups through any other issue.

As Minister Roxon made clear, this decision has been made on the basis of the cost of new drugs and the PBS overall. But the PBS cannot and should not be viewed only as a cost to Government – it must been seen as a fundamental and, indeed, successful investment in the health of the nation as a whole.

Medicines can save the health budget money through reduced need for other clinical interventions, particularly at the high-cost acute end of the health spectrum.

Further, savings are not limited to the health budget. Other parts of the economy benefit through increased workforce participation and increased engagement with civil and social society.

And perhaps most importantly, the biggest gain is for the improvements in quality of life that these medicines can bring to consumers.

And these are actually the sort of decisions that PBAC is best qualified and experienced to assess.

It would be interesting to be a fly on the wall when Cabinet is deciding on which medicines should be subsidised.  What information will it take into account over and above what PBAC already provides?   What other financial and budgetary information is taken into account and who supplies that information?  Given that many other health and policy interventions are not assessed for cost-effectiveness at all, how can Cabinet confidently know that other priorities will actually provide additional benefits for the public spend?

Despite the undoubted collective wisdom and expertise around the Cabinet table, I do not see how this process will improve the bang for the Government buck

This is an ill-considered, short-sighted policy decision taken for short term budgetary reasons and without a proper assessment of the impact on the most vulnerable in our society – those afflicted with sudden sickness and the chronically ill.

We urge the Government to rethink the decision – what could be more important than the health of our nation?

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