Less than 100 hours ago, Health Minister Mark Butler boasted of his need to 'nudge' the health technology assessment processes he had previously described as "clunky" and responsible for preventable deaths.
Minister Butler announced the second women's health package last weekend, highlighting his need to intervene in the evaluation process to correct a three-decade-old failure.
Health department officials confirmed at a recent Senate Estimates hearing that the failure identified by Minister Butler reflected an enduring lack of flexibility in comparator selection.
Yet, the Minister now defends the inviolability of this system against criticism from the US-based industry that simply parrots his own.
The politics are understandable, but what is he defending?
What is the PBS? Is it a system that provides universal subsidised access to prescription medicines? Or is it the decision-making framework based on contentious economic modelling that has faced widespread criticism, including from the responsible minister, who acknowledged that people die because of its failings?
It appears that many believe it's the latter, given that the US-based industry has never challenged the public health benefits of any prescription medicine program based on government subsidies. Its criticisms are confined to pricing policy, including Australia's "clunky" use of health technology assessment.
The US-based industry restates many of the criticisms we hear from Australian stakeholders, including the minister, in its criticisms of the PBS. Its criticism reflects the reasons for launching the much-hyped Health Technology Assessment Review. Many of its criticisms are lifted directly from stakeholder submissions.
So, what's the problem?
Some hyperventilate about US intervention in the PBS. Yet, since the introduction of the statutory requirement for pharmacoeconomic evaluation in 1993, the US government has been responsible for the only substantive improvements in the system.
The system is more consultative, transparent and accountable because of the inclusions in the PBS side letter to the 2004 US-Australia Free Trade Agreement.
Pre-submission meetings with the Pharmaceutical Benefits Advisory Committee (PBAC), the ability to respond to Economics Sub Committee evaluations, PBAC hearings, the timely communication of PBAC outcomes, and even monthly listings were all either introduced as a result of or guaranteed, following intervention by the US Government.
Remember that the Australian government resisted every one of these changes. Does Minister Butler believe these changes are bad and should be reversed? If enhanced transparency and accountability are only possible in response to another country's intervention, we should hope for more.
