Michael Oberreiter, Roche’s Head of External Affairs International, has visited Australia for a series of discussions that spanned pharmaceutical policy, global pricing tensions, innovation systems, and the deep structural challenges he sees emerging across health systems worldwide.
What emerged during a conversation with BioPharmaDispatch was a striking mix of admiration for Australia’s strengths and concern about its future access to health innovation and the potential implications.
Oberreiter, whose three-decade career in the global pharmaceutical industry has taken him from Austria to Singapore, China, Germany and beyond, describes himself as an “accidental” entrant into the industry.
He began as a bookseller in Vienna, was drawn into health policy after a chance conversation with a government minister, and went on to build his reputation in market access through early work on reimbursement reforms for rheumatoid arthritis. What has shaped his worldview is not just the countries he has worked in, but the extreme diversity of systems he has navigated, from advanced health technology assessment (HTA) frameworks to emerging-market capacity-building programs.
During the discussion, Oberreiter repeatedly returned to a central concern that Australia's HTA and reimbursement machinery have drifted far from their intended purpose. Many nations, he said, fall into two camps. Some still treat HTA as a decision-support tool, and others have turned it into a cost-containment weapon. “If I put Australia somewhere,” he said, “it is more like a cost containment tool.”
The consequences, he argued, are already evident in access delays, outdated standards of care, and clinical trial attrition. He recalled Roche’s experience launching a melanoma therapy in Australia. He said that while the treatment transformed survival worldwide, it took Australia several years to reimburse it. “We did not get reimbursement for years in a row,” he said, describing a system structurally designed to delay.
Australia, he warned, is not alone, but a "whole emerging new architecture that's coming from a particular country" is magnifying its challenges.
In a blunt assessment, he said the United States has finally lost patience with subsidising access to innovative medicine in other wealthy nations. The Trump Administration’s 'Most Favoured Nation' pricing strategy, he explained, is no temporary political experiment. “It would be very naïve to believe it’s a temporary thing.” The message from Washington is clear, he said, countries must “increase their spending in innovative medicines” and “optimise within their existing systems,” or risk trade and diplomatic consequences.
For Australia, which spends among the lowest per capita amounts on innovative medicines among developed countries, the implications are direct. While public debate here often focuses on costs, Oberreiter said the real issue is that Australia has never conducted the deeper intellectual conversation that frames HTA reform in places like Germany. German policymakers, he said, initiated a recent reform process with a single question. They asked what kind of society we want Germany to be, and how the health system should reflect that. What flowed from that were discussions about patient-relevant benefit, economic productivity, health equity and long-term industrial strategy.
“That’s not the conversation happening in Australia,” he observed. Instead, policy debate gravitates to guidelines and technical modelling, rather than broader societal objectives. He believes this is a dangerous limitation. “HTA in service of what? If you continue to use this as a cost control, I can predict you will end up with a system where you will not get access to the newest technology.”
Oberreiter stressed repeatedly that he is “a huge fan” of rigorous value assessment. But HTA, he argued, has become ever more complex, ever more layered, and increasingly divorced from the real-world performance of medicines. Regulatory agencies, he noted, are moving in the opposite direction, exploring AI-enabled submissions and cloud-based evaluations designed to bring innovation to patients faster. HTA bodies, by contrast, are adding friction. “This is the super-increasing gap that we now need to manage,” he said.
He also highlighted a looming structural challenge, Australia’s workforce shortage. Innovations that enable decentralised care, such as subcutaneous formulations, home-based therapy, and telehealth-delivered models, are precisely the kinds of solutions a strained system needs. Yet under current HTA modes of thinking, these innovations are often penalised, triggering price cuts instead of being rewarded for easing hospital and workforce pressures.
Despite his concerns, Oberreiter’s assessment of Australia remains optimistic. He praised Australia’s efficiency in delivering medicines once they are reimbursed, its capability in decentralised care, and its strong clinical infrastructure. The issue, he said, is not capability, but mindset.
“You’re not an island anymore,” he said. “There are so many countries around the world now who are ahead of you, who have understood that health is an investment.”
For Australia, he believes the path forward should begin with a single question. Does the nation want healthcare to be a cost to contain, or an economic and social asset to cultivate? Everything flows from that choice.
