Assistant Health Minister Ged Kearney officiated the public release of the Health Technology Assessment Review final report at Pharmaus in Canberra last night.
Speaking on behalf of Health Minister Mark Butler, she delivered a brutally honest assessment of the choices confronting the Albanese Government, the industry, patients, clinicians and stakeholders.
Assistant Minister Kearney's address matched the honesty of former health minister Sussan Ley's address at the corresponding event in 2015. During that speech, Ms Ley called on stakeholders to propose options for PBS reform, which resulted in the $6.6 billion PBS Access and Sustainability Package.
Assistant Minister Kearney's address on the HTA Review's final report should be viewed in two halves.
In the first half, she highlighted the review's recommendations as an opportunity to accelerate funded access to the best medicines and health technologies. In the second half, she discussed the cost and the realities of the review's recommendations for the medicines and health technologies that do not meet the first criteria.
This is the trade-off confronting all stakeholders, including the industry and patients.
For companies, the review's recommendations mean that the primary purpose of the vast majority of their medicines would be to reduce the cost of already funded therapies and help fund the small number meeting the criteria of providing improved outcomes for high unmet medical needs.
Many will welcome the proposed 'bridging fund' that would "support earlier access to exceptionally promising, time-critical therapies." They will also welcome changes to the managed access program. However, they will apply to a small number of medicines.
Assistant Minister Kearney was not so subtle in suggesting that the cost of these reforms would be funded via other changes.
She said that "every dollar spent on a medicine that is no longer best in class is a dollar that doesn't get spent on one that is" and that "every dollar spent on a treatment that isn't cost-effective is a dollar that doesn't go to treatments that are". She added, "Every dollar spent on a therapy that delivers only marginal benefit is a dollar not spent on a truly life-changing one."
Read that again and consider the implications.
Assistant Minister Kearney says that the Government should not fund medicines that deliver a 'marginal benefit' because this would prevent the funding of life-changing medications.
When did this even become an acceptable policy position in Australia?
Is the Albanese Government intentionally adopting Pharmac's language in positioning the funding of medicines as a zero-sum game? In effect, the statement means a system where investment in new health technologies formally requires disinvestment in others.
The inevitable consequence would be a system that pits patients against patients and clinicians against clinicians, further subordinating their human needs to HTA.
This is a perilous approach to decision-making. Yet, nobody should be surprised, given the HTA Review report mentions the word 'disinvestment' 24 times.
We have seen this language before, and not just with Pharmac. In the 2013 National Commission of Audit, the former Coalition Government was advised to adopt Pharmac and implement a system under which medicines could only be added to the PBS when another was removed. Thankfully, its recommendations were rejected, and for excellent reasons.
Who decides what constitutes a 'marginal' benefit? The new Pharmaceutical Benefits Advisory Committee, with its expanded remit and powers. The last time the committee had its powers expanded was almost two decades ago when it was given effective oversight of the National Immunisation Program. Has funded access to vaccines improved since then?
Minister Butler and his stand-in Assistant Minister Kearney deserve full credit for their honest presentation of the HTA Review report.
Stakeholders who tend to consider the recommendations they like need to follow the lead of Medicines Australia chair Anna Lavelle, who said they need to be considered holistically in a speech to Pharmaus this evening. It was a prescient statement.
The report's recommendations involve a wholesale reform of HTA decision-making that, if adopted, would grant the institution far more powers. Companies would cannibalise each other in desperation to avoid disinvestment. Patients would be pitted against patients and clinicians against clinicians.
The HTA Review has been consistently described as 'generational' in its ambition. This is true, but whose ambition?