Comment

Researchers at the University of Sydney have remarkably found a correlation between a company's product portfolio and the patient groups it funds.

The PBS pie is not growing and the structural reforms that have delivered billions in savings are close to exhausted - where will the money come from and is conflict inevitable?

The year ends with multiple unresolved issues and the sector facing significant uncertainty as it looks ahead to an election in 2019.

In barely half a year, the government's budget bottom line has improved by over $30 billion, and it is now forecasting an underlying cash balance surplus of $19 billion in 2021-22.

While the PBS fights for every dollar and to keep what it already has the federal government has announced a new billion dollar pre-election health grants program for, well, anything it wants to spend money on.

Are the new operational guidelines about keeping DHL out of the CSO or giving the company a conditional pathway to gain its share of the annual $200 million in subsidies paid to CSO wholesalers?

At what point does the sector decide to set aside its differences and rally together to oppose or at the very least delay the reform?

How would companies respond if the government confidentially negotiated a change in the PBS with another stakeholder group?

The wider context in 2019 and 2020 will be the apparent return to PBS growth, a significant shortfall in savings, the need to fund new listings and whatever is negotiated as part of the next 7CPA, and a process that deems the reimbursement of some medicines as something other than a priority.

Is industry at risk of backing a system reform that explicitly prioritises the interests of some patients over others? Is it at risk of being in a position where putting patients first actually means putting some or only some patients first?

The industry already has extensive experience with a 'prioritisation' process. Who remembers the 2011 deferrals policy and has any experience with the technical group advising New Zealand's PHARMAC that prioritises every medicine it recommends?

If Labor wins the next election, Catherine King will have many significant decisions to make in her first weeks and months as health minister, including whether to stick with the sector's strategic agreements.