SPEECH TO PHARMAUS18
MONDAY, 17 SEPTEMBER 2018
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Good afternoon and thanks for having me back. It’s always a pleasure to speak you all.
I’d like to begin by acknowledging the traditional owners of the land upon which we meet, and I pay my respects to their elders past and present and emerging.
And right at the outside I’d like to acknowledge the new Medicines Australia leadership team of CEO Elizabeth de Somer and chair Anna Levelle.
This is the first time a woman has occupied either of these key roles. I want to reflect on this fact for a moment because I do think it is significant.
In five years as Shadow Health Minister I shudder to think how many stakeholder meetings I’ve had – many thousands probably. And it remains the case that in the health industry – as in so many others – that men still dominate senior roles.
I’m glad to see that’s starting to change.
It’s significant too women make up half the MA board and a significant number of your executive roles. So well done. You’re doing a lot better than the Federal Parliament, frankly.
You may have noticed there has been a pretty heated debate in this place in recent weeks about the role of women in public life. Do we do enough to encourage women into Parliament? And do we treat them properly when they get here?
I’m proud to belong to a party that has made great strides in recruiting and promoting women since I first arrived in this place 17 years ago. We’re now very close to reaching our target of 50 per cent female representation.
I could say some very disparaging things about our opponents in this regard – but I’ll restrain myself.
While on the issue of leadership I also want to pay tribute to your former chair, Wes Cook.
When you’re well ahead in the polls and an election is looming suddenly everyone wants to talk to you. People and groups who’ve shown no interest in engaging with you for two or even five years suddenly decide you’re worth their time.
But Medicines Australia – both under Wes and now under Liz and Anna – has never been like that.
You’ve engaged with me and my Labor colleagues consistently and constructively for the last half decade.
After five years as Shadow Health Minister I hope very soon to transition to a new role … and if so I’m sure I’ll continue to have a very good relationship with MA.
Now, our opponents like to claim that Labor is anti-business.
I hope Medicines Australia and your members can see through such nonsense.
I hope we’ve demonstrated through our engagement that we hold the pharmaceutical industry in high regard.
Your work not only contributes to the health of our nation, but to the health of the world.
You employ 15,000 Australians – including some of our best and brightest – and that number is growing.
You export $3 billion of vaccines and medicines – making you a major economic contributor.
And most importantly, you are a life-saving innovator. Each year around 700 clinical trials are commenced, each with the potential to transform lives and make medical history.
So we value you.
And I hope you’re never in any doubt about Labor’s commitment not just to medicines policy but to health policy as a whole. There is no more important project for us than securing and improving Australia’s universal healthcare system.
So let’s now turn to some policy substance.
First I want to say a few words about your new report on early retirement due to poor health.
This report offers further confirmation – as if any more were needed – that prevention and early intervention programs should not be seen as costs but rather as investments.
It illustrates once again that poor health doesn’t just cost people individually.
And it doesn’t just hit the Commonwealth – and therefore taxpayers – for the cost of care and welfare.
It costs them, and the economy more generally, billions of dollars in lost productivity and super.
So thank you for this important piece of work.
Now on to medicines policy.
The PBS has given Australians affordable access to medicines since it was established by the Chifley Labor Government more than 70 years ago. Along with Medicare, it is one of the linchpins of our universal health system.
It is underpinned by the National Medicines Policy, whose key objective is to ensure “timely access to the medicines that Australians need, at a cost individuals and the community can afford”.
Today, I want to talk about two challenges to that objective that either side of politics will face in the next term of Government.
The first is the challenge of subsidising recommended medicines in a timely way.
In the last decade, governments around the world have struggled to reconcile two new trends: the post-GFC decline in their revenues, and the rise of personalised medicine – which promises more effective treatments but at a higher cost.
The challenge is reflected in the delayed and denied listings that we have seen under the Coalition Government. Because while it is easy to say that you will list all medicines recommended by the PBAC, the Government has proven it is harder to do.
For example, Senate Estimates has revealed that the Government has not listed at least nine recommended medicines because pricing negotiations have broken down. Some of you know that directly.
Those sponsors were committed to giving Australians affordable access to their medicines. They had gone through the effort and expense of the TGA and PBAC processes – only to be forced to withdraw their applications after positive recommendations.
The consequence of that is that Australians have missed out on access to vital medicines for juvenile diabetes, osteoporosis and other conditions.
The Government also continues to delay listings unnecessarily.
A PharmaDispatch analysis of August 2018 listings, for example, showed that medicines were delayed by an average eight months after PBAC recommendation – and up to 13 months in some cases.
The Government might argue that pricing negotiations are complex and sometimes difficult. That is true.
But the Department of Health’s Annual Report shows that for one in seven medicines, there is a delay of more than six months after agreement on price.
Those delays can only be caused by ministerial and Cabinet processes – by the challenge of subsidising new medicines to which I refer.
That challenge has been exacerbated by the Government’s failure to reinvest PBS savings in new listings.
As many of you know, the former Labor Government established a ‘notional bank’ to capture medicines savings made under successive governments.
But clearly the bank was too notional, because the capacity to reinvest those savings in new listings was lost with the election of the Liberals in 2013.
In recent months, I have spoken with many of you about the possibility of a legislated Medicines Fund.
I do think such a Fund would help to put PBS expenditure beyond political cycles, and provide a first port of call to offset new listings.
But a Fund also poses questions, including where seed funding would come from and whether the Fund could be perceived as a de facto cap on PBS expenditure.
I look forward to further discussions with Medicines Australia and your members on this concept in the months ahead.
National Medicines Policy
The second challenge is to consider medicines policy in a more holistic way.
I welcome the Government’s work on some issues, including the Life Saving Drugs Program, pan-tumour indications and supply chain arrangements.
But I also agree with Professor Andrew Wilson that the National Medicines Policy has been undermined by “piecemeal approaches”. For example, while streamlined TGA processes are of course welcome, there is a risk they will just shift the existing ‘bottleneck’ from registration to subsidy.
I think we need to take a holistic view of the entire medicines ‘pipeline’, from research and development to the quality use of medicines by consumers.
When you take that perspective, you see developments that present opportunities but also challenges for the National Medicines Policy, including:
- An increasingly competitive global environment for innovation and clinical trials;
- Increasingly targeted medicines, such as for rare cancers and other rare diseases, that have limited data and high unit costs;
- The benefits and risks of managed entry schemes in subsidising these medicines;
- Other new therapies that aren’t traditional ‘medicines’ or ‘services’ and therefore fall between the cracks of PBS and Medicare; and
- Evidence that large numbers of Australians are struggling to afford medicines and in many cases not filling prescriptions.
Addressing these challenges will require a genuine partnership between the government of the day and all medicines stakeholders: researchers, medicines companies, distributors, pharmacists and other health providers, and most importantly patients.
Labor is committed to that partnership.
My colleague Kim Carr has already announced that a Shorten Labor Government will re-establish the Pharmaceutical Industry Working Group.
We think that’s an important forum for engagement with your industry and we still can’t understand why it was abolished by the Liberals. The pharmaceutical industry needs a forum like the PIWG so that industry and government can work together to achieve our shared objective – to more medicines more accessible.
I have also said previously that community pharmacy agreements affect all medicines stakeholders, and that a broader range of stakeholders need to have a seat at the table for negotiations on the next agreement.
That’s why a Shorten Labor Government will lead early and inclusive negotiations towards a new agreement.
And importantly, we’ll honour any agreements we make. Everyone in this room knows that has not always been the case under this Government.
So there you have the broad outline of how a Shorten Labor Government will approach medicines policy.
Not – I must caution – that we’re taking anything for granted.
Labor has only won Government from opposition three times since the Second World War. It’s no easy feat.
And anyone who tells you in the post-Trump post-Brexit world that any election result is a sure thing is kidding themselves.
So we’re not resting on our laurels.
We will continue to put out policy right up to the next election as we seek to convince the public beyond a shadow of a doubt we have the values, ideas, policies and team to lead the nation.
That will include more detailed policy in health and medicines. So watch this space.
In the meantime, I’m happy to take some questions.