Company rebates fall for the first time in years, lifting net PBS costs

The current agreement between the Commonwealth and the research-based pharmaceutical industry promised faster access to new medicines through HTA reforms. Four years on, that reform is still unfinished. In the first of two articles, Jody Fassina of Insight Strategy asks what was promised, what was delivered and who pays while patients wait.

A newly released document has, for the first time, revealed forecast net spending on the PBS to the end of the decade after rebates, and it's not good news. Why are officials calling it a new 'charging' framework instead of cost recovery? The documents provide a critical piece of intelligence that leaders must consume, and why history matters.

The Commonwealth expects to spend about the same on the Pharmaceutical Benefits Scheme at the end of the decade as it does this year, after accounting for rebates paid by companies. Has it already budgeted a new savings framework?

Surely the issue of sustainability, raised by a senior official during Friday's webinar and long defined as not paying too much, deserves reconsideration. The PBS is becoming unsustainable because of the 'Faustian bargain' that, while well-intentioned for so many years, is now killing the program's ability to meet its policy objectives.

Services Australia's 2025–26 annual report reveals the agency processed 233.6 million PBS services, down from 243.4 million in 2024–25.

The Department of Health, Disability and Ageing has committed significant resources to a Canberra consultancy to build a new "charging model" for assessing medicines, vaccines and medical devices for public subsidy. It has not said publicly what the model covers, what it could mean for the fees companies pay, or when stakeholders will see it.

Dr Brian McNamee AO will retire from CSL's board in March next year, and Gordon Naylor, who has served as Interim CEO and Managing Director since February, will become the company's chair.

As current agreements have shown, trying to fix today's problems often creates new, even worse ones. Industry groups should approach the next agreement negotiations with 2031 and 2032 in mind, not the problems of 2026 and 2027.

Millions of Australians have shown they will pay full price for prescription medicines they want. They have shown less appetite for paying for vaccines they are told they need. As pressure on public funding builds, that may not hold.

Australian biotech Recce Pharmaceuticals has signed a deal with Arrotex Pharmaceuticals to sell its experimental topical gel for diabetic foot infections in Australia and New Zealand.

CSL has named Deborah Waterhouse, a British pharmaceutical executive who helped negotiate Australian medicines policy more than 15 years ago, as its next chief executive and managing director.

GLP-1 medicines were a key part of the update. Sigma said the business was still growing even though the first sales boost from these medicines is now in the base. "Growth is encouraging as we have now cycled the initial structural uplift from the introduction of GLP-1 sales," Managing Director and Chief Executive Vikesh Ramsunder said.

Britain has made an expensive, public bid to win back pharmaceutical investment, and it has not yet paid off. That is the finding of Open for Business, a new report from consultancy Evohealth, which describes the UK's effort as "a commitment, not yet a conversion".

Telix Pharmaceuticals has reaffirmed that it will pass US$1 billion in revenue and other income this year. Its third-quarter sales were consistent with the previous quarter, and it is working through a US$1.65 billion merger.

BioNTech has opened its clinical-scale mRNA manufacturing and research facility at La Trobe University's Bundoora campus, nearly three years after announcing the plan.

If anything, it is remarkable that patient groups advocate so strongly for access to medicines when the companies that make them provide so little of their funding. Advocacy that persists without the money cannot be explained by the money. It is explained by what patients need.

It reflects a maturing market. Growth no longer depends only on new patients. It also draws on a large and growing pool of former users, many of whom stopped because of cost or a dislike of injections, and who may return when the product, price, or format changes.

Patient groups in Australia and New Zealand are the most active in the Asia-Pacific region in putting patient cases to medicines regulators and funders.

A new paper published in the MJA warns that pharmaceutical companies' money threatens the independence of patient groups. Its own numbers tell a different story, and the biggest funder of consumer health advocacy goes unexamined.

The research-based industry is considering pushing for a reference pricing law in its new agreement with the Commonwealth. The risk is that the Government agrees, because while a policy can be set aside, a statute is mostly immovable.

Oncologists have been having these conversations for so long that Private Cancer Physicians of Australia now runs communication skills workshops on discussing high-cost medicines. Every oncologist and haematologist "will have their stories", Steer said, and many patients turn to groups such as Rare Cancers Australia for help raising money.

Welcome to the first podcast video recording. Recorded at the recent Pfizer Invites event, this episode focuses on the rapidly emerging private market and whether it can catalyse meaningful medicines reform to benefit patients who are either waiting extended periods for funded access, paying for it themselves, or missing out altogether.

Medicines Australia has added two new directors to its board. Anne Harris of Novartis and Ed Hollywood of Boehringer Ingelheim. Ms Harris's could prove critical as the only director who was there for the negotiation of the current agreement.