As the Albanese Government considers the still secret recommendations of the Health Technology Assessment Review, it is worth considering the historical context.
Australia became the first country to adopt a legislated pharmacoeconomic requirement for medicine reimbursement in 1993.
What was the intent of this system when the parliament considered the enabling legislation in 1987?
The National Health Amendment Bill (No.2) 1987 (Bill) was introduced to the parliament in 1987.
Based on a review of the Bill and its explanatory memorandum, it is difficult to argue that the intent was ever to establish a system with the technical complexity and process medicines and vaccines are forced to navigate.
Creating the pharmacoeconomic requirement was a secondary item in legislation significantly focused on introducing a new pharmacy payment system.
It does not mention the term health technology assessment, which has become an almost ubiquitous feature of policy-making because, at the time, it was a niche field of academic endeavour at a small number of universities.
In fact, the Bill describes the new pharmacoeconomic requirement in just 94 words.
It simply says, "The Pharmaceutical Benefits Advisory Committee, which recommends to the Minister which drugs should be listed as Pharmaceutical Benefits, will be required, when deciding whether to recommend that a new drug be so listed, to take the relative cost-effectiveness of the drug when compared with other available drugs and therapies into account and to state if recommended drugs or medicinal preparations are more costly a that it is satisfied there are advantages in their use for some patients. Such amendments are aimed at discouraging the prescription of expensive drugs where more cost-effective alternatives are available."
The Bill amended the National Health Act 1953, establishing the pharmacoeconomic requirement with 81 words in Section 101(3A).
In 1987, it said adopting the pharmacoeconomic requirement would cost just $500,000. The Department of Health and Aged Care now claims it costs over $40 million yearly to administer HTA and pricing processes related to the PBS and National Immunisation Program. The claim equates to around $150,000 every working day.
A policy intent described in less than 100 words, implemented with an 81-word legislated amendment, has evolved into Australia's vast and sprawling HTA industry and institutional decision-making structure. Was that ever the intent?
