The 'Dispatched' Podcast
BioPharmaDispatch - discussing the issues impacting the Australian biopharmaceutical and life sciences sectors with Paul Cross and Felicity McNeill.
The 'Dispatched' Podcast
The 'Week in Review' Podcast - 2 March
A review of Senate Estimates, with irritating warnings, too much passivity, and passive-aggressive responses (0.00-4.50). Revelations on how oral contraceptives navigated the funding process and the drivers of that outcome (4.51-14.10). We disagree on the role of advisory committees in policymaking (14.10-25.00). The impact of individuals in health policy, how change can have a significant effect, and we disagree again on advisory committees and policy (25.01-39.20). Officials confirmed the HTA-driven go-slow on newborn screening at Senate Estimates (39.20-49.20). The challenge of ensuring equitable access to the newly-reimbursed oral contraceptives, given the need for a new prescription (49.20-55.30) and some worrying new policy announcements (55.30-66.50).
Hello and welcome to the dispatched podcast week in review. We're in March now. I'm delighted to be joined. My name's Paul Cross. I'm delighted to be joined by Mark Cohost for listening, McNeil PSM Cheer of Better Access Australia. Hi Licey .
Speaker 2:Hi Paul. Enjoying the heat.
Speaker 1:No,
Speaker 2:I'm living it.
Speaker 1:I have to say I enjoy, I only know two other creatures on this earth that hate the heat more than I do.
Speaker 2:You are Bassett.
Speaker 1:My Bassett Hounds. <laugh> . They , they absolutely hate it. It's because they're carrying around those big bodies.
Speaker 2:Yes. Your listeners need to visualize two dogs lying on the floor. <laugh> tummy's up for
Speaker 1:About 12 hours a day.
Speaker 2:Unable to move. Except when the dog ball was <laugh> .
Speaker 1:You know, I tell , you know , Maggie, she cos out because they don't walk, they don't walk far at the best of times because they are carrying around a lot of weight. But, but they, which is how the ambassadors are built that way. But she gets about three or 400 meters into a 600 meter walk in this kind of feet . And she just has to have a five minute break.
Speaker 2:Yeah.
Speaker 1:So she decides she's gonna lie down and just have little
Speaker 2:Snooze. That's why we don't walk your Bassett and my oodles together.
Speaker 1:<laugh> , I
Speaker 2:Know my oodles that can run for 12 Ks and still go. And now we ,
Speaker 1:They have very different energy levels. Mm-hmm
Speaker 2:<affirmative> .
Speaker 1:Quite a bit to talk about. We had community affairs, legislation committee, senate estimates last week. It was pretty good.
Speaker 2:Can , can you please be respectful? Explain how we're gonna engage today . Where does
Speaker 1:Paul from Yeah . Where's, where does that come from? All of a sudden,
Speaker 2:I , I liked your idea. They've been sitting on q they've
Speaker 1:Been sitting on Qantas flights too often. You get this lecture about how it's a safe workplace and we all have to act respectfully. Mm-hmm . Like , isn't that just a given? Mm-hmm <affirmative> . I mean, I would argue that that committee is far too passive in its questioning. I think Senator Rustin does a pretty good job.
Speaker 2:Yes.
Speaker 1:But there's a lot of passivity <laugh> from senators and a lot of passive aggressiveness from officials.
Speaker 2:Yes. Particularly to those who represent independents and minorities. And there is a real risk of Well, you see it, but
Speaker 1:They're quite rude.
Speaker 2:They're rude and dismissive. It's like, as if you'd lost that typical,
Speaker 1:But Well, they need to check their tone . Yeah, absolutely. They , they , they , they really, really do. I find the other committees, I dunno , I've watched a bit of , uh, the Foreign Affairs Homeland Security one. Well,
Speaker 2:There's one that's respectful, but don't give me Codswallop or else
Speaker 1:James Patterson, who's the shadow, see ?
Speaker 2:Yeah . Shadow. Home affairs.
Speaker 1:Home affairs. Yes . He's, he's very good. He's just completely, he'd be a management consultant if he was <laugh> a senator. I'm sure he's like the Oscar pry of the , the Senate. He's just so, he's gonna love that. He's got no emotional range or this very narrow emotional range. So the, his , his interlocutors mostly officials, but also ministers. 'cause the ministers tend to be in those hearings. Uh, they, yes. They get very irritated. So you had this great exchange between Penny Wong. He's got quite a similar style, I think. And James Patterson were just, it was just a monotone off.
Speaker 2:It is. And people struggle when people don't react emotively when they just continue to go . No, no, no, no. And ironically, if you see some people build up even more to become even more emotional to try and gown an emotional response from the detached individual. So it's why they're great under pressure against, hence why Oscar's such a great F1. Right . I guess he is so calm and zen whether he wins loses or crashes.
Speaker 1:Yeah. Yeah. It's, it's, it's interesting. It's interesting because I , I work for two ministers. One was a senator mm-hmm <affirmative> . And one was not. And we, when, when our minister was in the house of reps, we didn't really care that much about estimates. That was, that was the officials problem Guess that the officials to be , that's , that's their problem . To be sorted . Yeah . It's their problem. We'd have it on in the office, but when your , your minister has to actually sit there and it's their portfolio, it's a completely different ballgame.
Speaker 2:Mm . You don't want 'em to look like a
Speaker 1:Fool. No. Because at that point, most of the questions are directed to the minister. Mm . But I did think we got some interesting revelations about what happened on the oral contraceptives, and kudos to Larissa was Senator Larissa Waters. It's pretty rare that I praise the green these days. But she asked some really interesting questions about, well, how all of a sudden did the comparator issue resolve? Resolve? Apparently there was this stakeholder meeting <laugh>.
Speaker 2:Well , we've never had one of those before.
Speaker 1:They made it out to be , you used the Trump Zelensky comparison. You said it was like they made it out to be this meeting of sort of massive significance. I said it was , it was a bit , you know, they made it out like it's a mysterious and complex as the first meeting between Montezuma and Ernan . Cortez
Speaker 2:<laugh> . Yep .
Speaker 1:Uh, <laugh> . But you think about it, so in that if it was Trump and Zelensky, or the Aztecs and the Conors, who is the industry and who is the department? And
Speaker 2:Heaven forbid, where's
Speaker 1:The patient <laugh> . So, so , so you would say that the, the See, I think the , as the industry would be the Aztecs. Okay. Because they have the , I mean, the , the Spanish looked at the Aztec civilizations and went , wow, this makes us look really, really bad. You know? So they had this great sophistication and technological adv advance, the Spanish had guns. And that's a bit like the government, you know, and you end the government , government <laugh> , you know , what matters is, is what weapons you have Trump zelensky. I don't know . That was extraordinary.
Speaker 2:That was, yeah. Um , I'm trying to find the words to articulate the, the, the change in that. I mean, as , as I was saying to you earlier, whatever we thought of that , uh, the president has got what he wants, which is suddenly everyone in the EU standing up saying, we must lead. We must protect Europe. We must lead this. We will sort this. We must fund this. I thought, wow, well done. You've actually got what you wanted. Um, and again, we always talk about President Trump using that original, putting something outrageous on the table to see how people respond to start the discussion and the negotiation. But I also think President Lansky's , uh, approach perhaps misread the room a bit too, and caused a bit of a,
Speaker 1:The shame of it is that if you watch the entire meeting as I have, 90% of it's very polite and courteous and respectful, and they're having a really meaningful exchange. And then maybe Zelensky made the slight just a little misjudgment of deciding to renegotiate the deal in front of the media. And I think it was the vice President made the little misjudgment of deciding not to accept that rather than just letting it slide. Yes. And yeah, it was, it was, it was, it was quite interesting. But as you say, you know, it's, the Americans kind of got what they want, which is they want the Europeans to do more, which I don't think is unreasonable.
Speaker 2:No , I don't think it's unreasonable either. But , uh, you know, it's also a good lesson for all of us. I read a very interesting , uh, analysis on Knowing your interlocutor and how that changes. And we all need to be mindful of it. Just because we are experienced in one form and with one group of people on a regular basis, doesn't mean we don't have to , uh, to those , I did a , uh, strategic session with this week, pivot , uh, our least favorite word, but suddenly appears everywhere. But when you have to pivot to, to adjust to your new environment and the new person, and I think we can get into a, a rush . I know you and I certainly work very hard to try and continually challenge ourselves in our thinking, not only about the issues, but the people involved in it. And it's always a great risk to a system. And I think our HTA system and the PBS is at great risk of this at the moment, because people, it's the same people. And I don't have a problem with the same people, but I have a problem with the same thinking. And so you don't see when there are opportunities to move and change. Now we've got contraceptives listed on the PBS and I'd , I'd like to talk about the train wreck that's now happening with that. Because a minister intervened because there was a women's health issue and an election commitment because a , uh, an assistant health minister decided to make something of it. And a lot of people got together to push and support that, because for a while it was flagging a bit, despite the inquiry in the parliament. And despite there being a, you know, a , a broader piece of policy work, it started to flag. And the fact that the original recommendations for the expansion of the indications were insufficient in July showed a system that went same old, same old. It took a minister saying, guys, I've made an election commitment here. So as the assistant is , you'll do this. We , we all know that's what was the spark. But it is a really good lesson for us all about understanding where, where does impetus come from? Where does change come from? And in the end, where is leadership and can you see it coming down the road? Can you see the new person that can do it? Can you see the new idea? And do you sometimes make the mistake of going in as the same interlocutor on the same grounds and on the same arguments, I would say that the PBAC and the department misjudged the minister and the elected government on what they would do with contracept, with the tick , we let them put it through. Yeah . Same old, same old. Now, we've all known about quality of life. We've all known about the differentiation between the , the modern contraceptives and the ones that were previously listed exclusively on the PBS. We've all known about that. But let's not pretend that any of those organizations that have been part of that evaluation and listing process paid due attention to it. The fact that they, for the first time in 30 years in this particular stakeholder meeting, as opposed to everything else that they've been told over the last 20 years, was their light bulb moment. Not no woman's ever sat in front of me before and said, this is what happens with the one you subsidize versus the one you don't come on. But I think it's a good lesson. I think they was Zelensky and Trump. I think the department and the PBOC had that moment where they said something and the minister turned around and went, you are not listening to me.
Speaker 1:Yes. Well , yeah. Yeah. I really wanna explore what's going on with these committees a little bit. But before we get to that, I , I think it is, it would be worth any company that's got an interest, any stakeholder that's got an interest in how these decisions are made. Having a very close look at this one. Mm-hmm . What was it? So why did Bayer, all of a sudden, these are old products, these , it's not like these are new products. These are old, I think they might even be off patent . But why all of a sudden did Bayer decide to do this? Now it could be that there was just one very passionate executive who pushed it very hard. I think that's probably what happened.
Speaker 2:Well, we had a big chat about that at your conference
Speaker 1:Last year. Yes. With , with the person <laugh>. And , uh, she was very passionate about it and very impressive.
Speaker 2:And also had read the opportunity too, which that had had been paying attention to everything that was going on politically and in the health system, and that there might be an opportunity. So when she put her job at risk to ask for that support within her company, she did it saying the environment has changed. It's kind of now or never, and full credit. Because the courage of saying, I'm gonna back this, let's go. And getting support from within that company to do that was really good.
Speaker 1:Yeah. It's not like it's a , a cheap process.
Speaker 2:No.
Speaker 1:Then you had a minister who was clearly, you know, you get the , you get the impression of a minister who's pretty displeased with the whole process, but you've been close to it. I've been close to it. Th this is an institution that is incredibly resistant to change , and more often than not, resistant to their ministers. And a ministerial request is as close as you're gonna get to a directive. Mm-hmm <affirmative> . And, and ministers deliver that in lots of different ways. I saw them delivered over , over the phone. Like , well, can you tell me about this? I think Greek Hunt did it a lot in very subtle ways. Um, usually it's just an expression of interest. Can you just gimme an update? You know, you call the PBAC chair, and if PBAC chair is smart, they go , uh, I think the minister's just asked me to do something. And that's, in many ways exactly how the system is meant to work. Let's just forget the notion of PBAC independence. I worked for a minister who made a request of the PBAC and they re rebuked the request. They didn't keep their jobs for much longer. So it's very difficult for these committees to do this . So they, they read the room as well once they got the request, but then the excuse we got about, well , all of a sudden it was the company's fault for not submitting quality data , which I thought was very, very funny. Really? Yeah. Really. And,
Speaker 2:And obviously you've never ever read one consumer comment that we've now learned how valuable our consumer comments are when we spend in that 10 week period telling the PBAC what it means to have access to a listing. Yeah.
Speaker 1:So that was, I thought that was, that was really, really interesting. The thing for me, where I get lost on these committees is, is they've become outspoken on policy matters. Mm-hmm <affirmative> . In giving their opinion publicly on how the system should operate. Now, I think you may have started this with that Cancer inquiry submission.
Speaker 2:Oh, it's my fault. I think
Speaker 1:It's your fault. I think that, I think that was kind of, that was a first really , uh, where they introduced themselves to the political process, which, you know, at the time I said, this is not a good idea. Mm-hmm <affirmative> . There was nothing particularly wrong with their submission. But it could have been written today. It could have been written 20 years ago. It's all the same stuff. It's everyone else's fault.
Speaker 2:I I, I'm going to , I'm gonna call you on that one, so Oh , yeah.
Speaker 1:<laugh> ,
Speaker 2:Sorry . We will respectfully discuss
Speaker 1:This. Remember, this is a workplace.
Speaker 2:I know it is workplace <laugh>. Where's my champagne <laugh> ? Um, but I , I am going to call that, because if we think about during that time, we've had deferrals, we'd had multiple changes. We'd had , uh, the heads of the committees being called to parliament, which is fine. They , you're perfectly entitled to call these representatives to appear as witnesses. And I think during that period, we'd also had , uh, the, was it insights or something that had done , uh, some Oh yes. Television on as well too, with
Speaker 1:That brilliant performance by Sue
Speaker 2:<laugh> . So , so let's set that all aside. There , there has always been a clear directive that the committees don't do policy. Mm-hmm <affirmative> . Okay . That , that they don't, that is not their , not their remit to design policy or to propose policies. They can ask questions of the department and the minister, but they're there to look at , uh, the listings and the , and the processes thereof . What we saw there was when a committee who also made up of people who have other jobs, who says, as a committee, we have an opinion on this and how we do our job. That's the point. Which, if you're going to be called to question and defend your job, and we saw that when , um, professor Sampson was interrogated by Senator Ti Wells , that was quite a experience. And again , um, professor Robin Ward, not most recently, but also when she appeared for the Medical Services Advisory Committee during that period about what it is to appear in parliament and be accountable to the parliament for what you're doing and why, and what you're taking into account. So when the PBAC of its own volition asked whether it could put in a submission, it was not directed Senator , uh,
Speaker 1:You could have said no, though
Speaker 2:Senator Dina Tali , who used to think we got them to do all sorts of things, but
Speaker 1:You could have stopped 'em from doing it.
Speaker 2:Could the minister have stopped them from doing it? Please don't always make it me. There are some things that I'm as the delegate of, and there are some things I'm not, can, could the minister have asked them not to? The minister could have asked them not to, but that would not be consistent with other advisory groups throughout the health system, which contribute. And this therefore also , um, requested to appeal. And I think once the parliament continually asks, you know, and we'd had three requests for appearances during that time for ADVI advisory Committee members to appear before them. Then we also have to think about the democratic principles and the parliamentary principles that if you are going to be called to give evidence, then you might need to be given an opportunity to actually express what that might be in advance.
Speaker 1:So for me, it's a chicken and egg. Yeah. You know, so if you were gonna start doing this regularly, I mean , they've poisoned the well on this HTA review. Now, now, that doesn't mean I'm a huge supporter of the HTA review. I think the whole thing is entirely , entirely a waste of time.
Speaker 2:Agree.
Speaker 1:Uh , and we're prosecuting the same arguments that have been had every year for the last 35 years. In fact, if you, if you went back in time to the mid 1990s and conducted a review with the same terms of reference, it would've identified exactly precisely the same issues.
Speaker 2:Well, I think it's exactly how we've got the first letter of the
Speaker 1:Legislation <laugh> , and precisely, the , the discussion has not changed now. And that's a lesson for everyone. My view is that if you are going to do this more often than the points of account , account accountability need to be adjusted accordingly. And
Speaker 2:So we agree with you on that. And , but I, I think we're having a slightly different conversation because my , you believe that the PBAC submitting to the cancer inquiry was the tipping point. That was when they were allowed into policy. And I feel like you are conflating that with their now commentary on full participation in the HTA review and now commentary on the HTA review. I think that was the flawed process, I think. But that was flawed also because the department should have been part , shouldn't have been part of it, nor should the industry have been on there. That should have been, if you really wanted it, not that you needed it, that process should have been truly independent. That should have been done by an external person. It should have been run with external people. And the department, the minister and the advisory committees should have been consulted as stakeholders in that report, not drafting and determining that report. And I see that as different. I see that when a department makes a submission to an parliamentary inquiry, you know, we are putting forward our position and our minister's position. And I do think it's just like in those areas, we had R-A-C-G-P and a MA and pharmacy and all these people put in submissions. They're putting in their point of view about what they do and why they do their jobs. And I don't have a problem with the PBAC, who's also expected to nominally have an annual report based on the submission processes. I mean, I think we went , if you go back to cost recovery and saying, we'll now report A-P-B-A-C report on submission processes, et cetera, you've started to create that accountability and response back, which at times can be done through the department, but you've started to poli politicize the, the institution and show it should be responding. You know, I think PBAC should be accountable to the parliament, but you know, I think they should be accountable to the A RT . Yes. 'cause I think we've got this huge gap. So, like I said, I, I see what you're saying. I have not found it appropriate the way the HTA review was done. I have not found, if that had been done independently, then I would've thought it would've been fine to give it to the department and the PBSC and SAC to say, please tell us what you think about that. Give us your opinions like you would to any other stakeholder group. Um, and now what , what , what would you like to , like the minister to give , you know, give consideration to as part of this broader remit? That's how it should have been done. But I think that is just , um, the department flexing its muscles over a weak sector and being able to get what they wanted out of that and to dictate it. And the moment that everyone agreed to those terms of reference and that membership was the moment it was gone. And I don't think that's because
Speaker 1:It was the institution.
Speaker 2:PC put in a submission in 2014,
Speaker 1:The institution reviewed itself, described itself as world class recommended some tinkering. It's now co-developing the implementation response, the government response. I dunno who , who else is , who The other part of that co-develop is, I assume it's the department. So it , it's basically conducted from start to finish a review of itself and decided that it's doing a world class job. And it's exactly, I use the analogy of the yes minister episode where they go to the hospital, it's got no patients, and they say we're one of the best operating hospitals in the NHS
Speaker 2:Up for the Florence Nightingale Award
Speaker 1:Up for the Florence Nightingale Award. And that's exactly what it , what it's exactly the same thing is that I think if you are going to have a role in setting policy and the framework in which you operate, which means that you, you are participating in the political process, then you have to be accountable accordingly. And so none of the No , no more of this exceptional attendance at Senate estimates hearings. No . You become a standard. I agree. Uh , part of that process, like the head of APRA is like the sports commission is ,
Speaker 2:Although we are gonna have to ask the current chair to perhaps not spend the first two minutes citing all of her experience
Speaker 1:<laugh>,
Speaker 2:Because each senator only gets five minutes. Oh ,
Speaker 1:Yeah . So I , I think, I think we're actually agreeing. See , I , I saw that that submission to the cancer inquiry as the thin edge of the wedge, that I, I think there should be a fence around them. Not, not literally <laugh> a fence around their operating environment. Because if , if you are, if you are operating in environment, which you also have a significant influence over how it operates and how it's meant to operate in the actual framework, it's a horrible conflict.
Speaker 2:I think that like, just like you've talked about the effectiveness and strength and weaknesses of the different ministers you have served. And I could talk about mine , but I don't because I'm a former public servant. <laugh> .
Speaker 1:I was a public servant
Speaker 2:Too. No , you're a mops, act <laugh> . It's different. We all know you're different. But I think that just like that, you, we have seen through the history of the PBAC, the level of pol politicization and interventionist nature of it, depending on who is the chair. And we do see like all, like all institutions and all committees, it waxes and wanes into certain spaces based on the priorities and approach.
Speaker 1:Personality is huge.
Speaker 2:And the remit that they have been given by GO governments when appointed, let's be very clear that all PBAC chairs are given a remit and instructions by their minister when they are first appointed about what they're expecting. Yep . And we've seen that ebb and flow. And we also see that also align with who may also be within the bureaucracy and how they can use leverage partner or detract and distract from that . So it's, it is a living organism and it is , uh, responsive to both the external influences, but the internal people who are ultimately driving and making those decisions. We are in another significant , uh, area of change in that area of the health system and in particular the health department. And we're seeing that at the moment about what is starting to flow through and how that will emanate and what will germinate from that in the next six months based on the changes that have taken place.
Speaker 1:It's a really interesting point. It's one of the hardest things for stakeholders to appreciate is that when the decision maker changes <laugh> , the way decisions are made changes. Absolutely . And you see that with ministers, you see with PBAC chairs. I , I , you know, you can go back to Don Burker , Lloyd, Sue Hill Andrew, and now Robin Ward. And there's a pretty narrow range of they , there's BAU on 90% of things, I suppose is what I'm saying. The personalities all very different. They're all very different. I mean, Sue Hill got in a lot of trouble, I would argue, because she, she's, she sort of the messed in pricing and the politics of pricing. And she , she , she did , she didn't do it. That that appearance she made on inside was just, I mean, she just signed her resignation. That was a resignation letter. It was. So, it was one of the worst things I've ever seen . The way she spoke down to the patient and humiliated that patient. I don't think she did it intentionally. I think it was stylistic. But then I would say that Andrew Wilson sort of carried on with a lot of the same ideas. He
Speaker 2:Charmed into disarms .
Speaker 1:He's just very nice. He's just a very nice person. He's just , he's very nice the way he does it. So a lot of the stuff that she kicked off on pricing, he continued and progressed quite frankly. But he did it. He's more successful because of the way, the way he did it.
Speaker 2:And just a little bit to be said about the industry's tolerance of a man versus a woman. And I , I do think she actually suffered a little bit from that because I think if a man had actually been given the same room , which she was given, and we need to remember sometimes that's not just all in her ideas. Everyone needs to remember A-P-B-A-C chair is given very clear instructions about the priorities for the government when they are appointed. And that's not always equally shared with us as the delegates of the minister, that we're not sitting in those meetings. That's a personal meeting about where to go and what to do. Um, and I think that during that time, I mean, that was the time where, let , let's be clear, this was a, a government that hid that there was offsets going on that had all sorts of secret pricing provisions in budgets that then would have to quickly be disclosed before the election was announced. So this was a, that was a government, the Rod Gillard Rudd government , uh, thank you Senator Patterson who reminded me how to articulate that were very clear. They were the ones that really attacked bringing the affordability of the PBS down and , and realizing what they saw were the savings opportunities from off patent medicines and also pricing reform that could be, could be leveraged. And she was appointed during that period. Now I know what I coped a little bit , um, in having come from finance and what people assumed and said about me, and I'm fine, I'm a big girl. But I also think that having come from Professor Sampson's time, where we were mostly in the, the , the era of listing and getting things done, I think that she inherited a really tough time of very different fiscal scrutiny of spending on the PBS. And I think she ran at it hard and sometimes didn't understand the difference between the PBAC running at it and the bureaucracy and ministers running at it. And I think she, that that can, that can go two ways. And you can, you can engage with the , the sector one way or another. And I, I think yes, it did some damage, but I don't think it was done deliberately. And I, I do think she got a little bit more of a hard time because of who she was. Yeah. I , and she was female.
Speaker 1:I, I agree on it . I think around that time, there are other examples too, particularly the way Susan Lee was treated. Yes. Particularly by the industry, but yes. You know, sometimes, you know, the person who kicks the door down isn't the one who should secure the room. Agree. And she did, she <laugh> cracked a few eggs and Andrew sort of made the omelet in a way, a lot of these pricing policies. But, and it look , I suppose, I mean, I can't imagine what it's like, 'cause like you have seen A-P-B-S-C chair appointed, and it is a very personal thing for a minister. They do literally speak privately mm-hmm <affirmative> . And it must be hard when you're A-P-B-A-C chair when a government changes and getting to the point of actually getting some direction from a , a new, a new minister , that that must be, particularly if a minister's not particularly interested <laugh> .
Speaker 2:Yeah. And I think the only thing I'd accountants do that is that I don't think that any PBAC chair actually has determined pricing policy. Right . I wanna be really clear on that. I don't think they've actually decided the pricing policy, the pricing policy still comes from the department and the government. What I do think they do,
Speaker 1:I'm gonna challenge you on that.
Speaker 2:What I do think they do is provide, if , if the government works out the bandwidth or the government works out the solutions, they tell you what they can reasonably apply. And then they take that and they leverage that policy tighter and tighter and tighter. 'cause that's where they're very good at, which is drawing the linkages between the various medicines to realize the savings.
Speaker 1:So I accept that, strictly speaking, the PBAC doesn't sign off on the policy, but they certainly have a role in formulating pricing policy. They've certainly done that.
Speaker 2:When
Speaker 1:2015, what , how many policies did you put before the PBAC to get their thoughts on?
Speaker 2:Well, they had input into policies. Yeah .
Speaker 1:So that's what , no, I'm not saying they don't sign the policy off. I'm saying they had a , this significant role in determining policy. Why does the government put policy proposals through PBA
Speaker 2:C ? They don't put policy proposals through PBA C they say to Pbac , this is what, this is what we are looking at. Do you see any clinical impediments to what we're doing? What
Speaker 1:About biosimilar oath flagging?
Speaker 2:Do you see any clinical impediments to what we're doing?
Speaker 1:Yeah. But that's, do you see
Speaker 2:Any clinical impediments to what we're doing, Senator?
Speaker 1:Yes . Well that's exactly right because you and I both know that the PBAC is used as a firewall against criticism, not just on specific products, but on certain policies as well. How do you mean supply , like biosimilar ? A flagging? 'cause that wasn't the original proposal. I've got the F fo I That was, that was their idea. No , that was their idea. And then Jeff McCall was put out to defender , not very effectively, I might say, but
Speaker 2:To be fair, it wasn't exclusively their idea. That was an idea that had been put forward by a number of stakeholders, which they were also aware.
Speaker 1:Yes. All right . But that was, they, they expressed a point of view. They did . And then went out and publicly argued for it. Yes,
Speaker 2:They did. Because it was a clinical matter that if you think about that time when the then chair of, sorry , chair then CEO of Medicines Australia, who is now a member of parliament. So I won't say any , their name told my minister, minister Lee , that the death
Speaker 1:Oh , blood would be blood is on your hands. Yeah .
Speaker 2:Blood , blood beyond her hands for the deaths of people because of biosimilar policies before it was actually recommended. And then
Speaker 1:The biggest member company became the first company to accept.
Speaker 2:Yeah. So that, that to me actually really was Oh ,
Speaker 1:That was beyond the pale.
Speaker 2:No. Yeah. Well, that was from the power . But I think that is absolutely a clinical issue to ask the PBAC to the PBAC. Is this something, you know, if if everyone's saying to us, you should definitely a flag . And we're like, well, you know, there is a big debate going globally and you published about it prof profusely, and told me that the only people I were following were the Venezuelans and others. And that's fine, because the point was everyone, the industry was being very effective globally of putting fear into people to say biosimilar. It's not the same, it's not like a small molecule. If your , if your pharmacist switches this, you never know what what happen to you. And that fear that was generated in the community was very real. And so going to A-P-B-A-C who under the National Health Act are about clinical impact and equivalences, and you say there are two options here, there are people that say that this could be a flag like everything else. Or do we need to have a different policy to actually bring these into the market, both for affordability and improving access because we can then, you know , uh, expand the restrictions. And they came back and said, we are comfortable with substitution. Now as a bureaucrat and not a clinical expert, as someone on , um, LinkedIn has been very clear to point out to me this week. I do take the advice from my clinicians to say, you see this stuff all the time. What do you think you will do? Because there is no point me having a policy saying, this is what I'm gonna do with substitution and pricing. If my clinical advisory committee says to me, well, we're not doing that in a million years. So that is a really good example for me, where policy is designed and with stakeholders and by the department and the government. And then it is our job to go to say, if we put this in, is this a policy you can actually implement? Because if you can't do anything with this in your capacity, then this is really poorly designed policy. So
Speaker 1:Who, was it a group of clinicians who, who gave that advice? Or a clinician?
Speaker 2:How do you mean?
Speaker 1:Well, how many expert clinicians were on PBAC at the time who were in a position to make those judgements ? Well , all because they didn't consult outside the PBAC.
Speaker 2:All PBAC officials. All PBAC members have the capacity to look at those things.
Speaker 1:Yeah. But it wasn't a , I don't want this to devolve into a debate on biosimilar policy because
Speaker 2:No , and I don't wanna hear that . If go ,
Speaker 1:I'm not ,
Speaker 2:I'm, but I'm also not going to divulge the discussions in the PBAC and who said what, or whatever. You've got the FY you've, we publish, we released it to you. Um, and you know that ,
Speaker 1:So that was , yeah, that was old . That's old school
Speaker 2:<laugh> . And if , well , and I don't have a problem with that because the , the community should know what we do, why we do it, how things are consulted upon and what things are changed. And they should have confidence. And because you think about it, there is a reason that PBAC members came out and talked about it because I had doctors from the a RA saying that, you know, the world was gonna crash in and we were gonna kill patients versus other people. For example, Jeff McCall, who was like that, a member of the ARA
Speaker 1:Said , and to his credit, said no , to his credit, he came out and made the , made the case publicly. He
Speaker 2:Was right as well .
Speaker 1:But as it turns, I mean, a flagging wasn't the right policy.
Speaker 2:But I mean , when I hear it , PPC doesn't determine policy law
Speaker 1:<laugh> .
Speaker 2:So
Speaker 1:You , okay , we're gonna agree to disagree. I know they don't determine it <laugh> , they don't determine
Speaker 2:It . My point is, but that , that is what was in, and that was about clinically whether, whether the policy is working and has the same impact as small molecules. We all agree. I don't agree that it's working. And like many things like price disclosure had to evolve . Like statutory versus nons, statutory price cuts had to evolve. 'cause no one was actually doing the, you know, the original 12 and a half . And we, we then eventually legislated it . Hello to all the former judges listening to <laugh> , my , my court evidence. But I think that's important. So I'm, I'm not arguing with you and whether PBAC or the department was right or wrong. The question is, who else was going to tell me whether, if that policy went through that committee was of a mind based on the evidence they saw on a daily basis, either in their, their clinical work or everything that was coming before them as as the full then 18 members of the PBSE. What did they think about it?
Speaker 1:And in fairness to you, at the time, the industry had been incredibly unhelpful on biosimilar policy.
Speaker 2:Oh
Speaker 1:Yeah. Where the , where the industry had been. Not, not everyone in the industry, but the industry had by and large played a very productive role on generics. To this day,
Speaker 2:My best testimony, end of senate estimates <laugh>
Speaker 1:To this day. What was the proposal? 12 point a 5% price card . Yes. That , so it would've been a ,
Speaker 2:It was less than , so by that stage, less than what was other , uh, generic . When medicines went off patent , it was 16%. And after two point a half years of allowing the industry, I , biotech Medicines Australia, the generics to work together , uh, and come up with solutions, we said, look, this is your area of expertise. You come up with ideas. We're not gonna tell you. You come up with ideas. And their idea was at the defne , well these are really sensitive medicine , so will it only drop by 12 and a half percent when one goes off patent? And it lists
Speaker 1:You gave them, you didn't respond to the letter, did you ? You responded Add estimates. Yeah. <laugh>. Yeah . Seriously, when I went , well, it wasn't a great idea, but that was, that was the first sign that is gonna be a rocky road on, on biosimilar policy. And it's why the government had no, no, no real choice. But to do the big catch ups in 2023. If you're not gonna give us a hand on bias , impulse , I know the GBMA have put some forward some things today or recently, I don't know where they go. Uh , but it seems to me that what the government does now is that for those in a community setting, hospital's great. There's four substitution 'cause of the tenders. Patients dunno what's going on <laugh> . But in a community setting, the policy's not working. And so they do what they, what governments do. Well, if you're not gonna give us a mechanism where we can generate savings, we are gonna introduce our own. Mm-hmm . Fair
Speaker 2:Enough. And yeah. And , and at BA we , we are kind of overall the , the complexity of, you know , price disclosure and biosimilars and stuff like that. We, we just want to abandon all of that and just say, let's just do, once something's off patent annual price cuts. Yep . Based on volume. And, you know, if the volume starts, you know, utilization of sales and irrespective of whether you know it's off patent or not, you can have these conversations, but I don't think that, you know, it's the right thing. You take what you've got and the comfort in a system with something and you, and you roll it out. And then what you have to be smart about is how you then tinker with it thereafter. And I don't think we were very smart with how it's been tinkered with since
Speaker 1:We have to talk about newborn screening.
Speaker 2:Okay.
Speaker 1:And which was brought up at estimates.
Speaker 2:Ah , yeah.
Speaker 1:And
Speaker 2:Thank you Senator
Speaker 1:<laugh> . Yeah. What , what can you say about this? What can you say? They , they promised 80 conditions in our ture . It's 76. 'cause California, they promised that our system would be essentially aligned to California. Mm-hmm <affirmative> . The Californians now have 85 mm-hmm <affirmative> . Which equates to 76 in Australia. 'cause different descriptions , uh, we have 32. We have 32. And the big boast is that after two and a half years, almost three years, really , uh, that we have national consistent, nationally consistent approach. So of those 32, the only reason it's 32, and the only reason they can talk about a nationally consistent framework is that the only tests that have been added since this,
Speaker 2:Well , the ones that were piloted under Greg Hunt . Yeah.
Speaker 1:The , the ones that the states have caught up who weren't doing some tests, particularly in Victoria h
Speaker 2:Galactosemia, which has been everywhere else for 30 years. People.
Speaker 1:And SMA was added because Greg Hunt ignored an ssec outcome and wrote directly to the states.
Speaker 2:Yeah. And then SCID and Fragile X , because they happened to be on the same essay . Um, also , uh, gradually flowing through, which I just wanna remind some people, this is how bad newborn blood spot screening was when I looked at some of these things when SMA, because there were other diseases that could be screened for on the assay. And this is when you want to have that conversation about, ah , what are these incidental might find somethings, there were diseases such as SCID that could be detected because of what that machine was automatically doing. And doctors were switching that off saying, I don't want to know. Right. Don't, so this , the test automatically screens for it because that's what it does, because it's sensitive and it can detect these things. And they were not asking for the result and asking for the result not to be processed and switched off in the , in the system. That's how stuffed our system is and still is. So yes, the 32 is nothing more than finally having everybody at the same place we were in 2018 when we um, when , when Greg can't ignored No , it's not
Speaker 1:A postcode lottery anymore. Everyone misses out.
Speaker 2:Yeah. It's really good that way. Yeah. Um, and you know, although the , the postcode now is , if you look at it, you can see pending and not,
Speaker 1:Oh , well that pending. Well ,
Speaker 2:No . Well ,
Speaker 1:Sickle's different, well , sickle cell was recommended 12 months ago. Yep . Health ministers agreed in September last year that they would add it. Mm-hmm <affirmative> . Not one jurisdiction has added it . No . So it's pending. Mm . But
Speaker 2:It's also, I I love that actually it breaks it down by state and territory. Some states and territory say pending some just say, all right , no <laugh> . So they're not even turning their mind to it yet. And this is why , uh, I am so incredibly frustrated and this is not what we advocated for and it's not what the government, when they went to the election, thought they were going to get the department to do or the departments to do. And it was supposed to be like the NIP where we evaluate it, it's on, and then we roll it all out together, like, you know , and as we know, if we need to get a vaccine out, we can get it out pretty much within six to 12 months. Uh, it's, it's a pretty simple thing. We added. We , again , this
Speaker 1:Is a lot simpler than a vaccine.
Speaker 2:It is a lot simpler than a vaccine. And if I read one more time, oh, we have to be careful and make sure about the safety and things that work. As if each time we add a new disease to newborn blood spot screening, we are suddenly introducing newborn blood spot screening for the first time. <laugh> , it's , the reality is so embarrassing . 99% between 94 and 99% of families will do except newborn blood spot screening when their child is born. And like I said, five babies every day are missing out on a diagnosis that at some point in their life will matter.
Speaker 1:The, what they have invested a lot of time in doing is doing brochures and fact sheets , fact sheets , <laugh>
Speaker 2:Got great infographics. People,
Speaker 1:I I I had a look at the fact sheet last week. And the , which one? The gay , the great case study they cite is Pompe disease. So this was the disease cited by the now Prime Minister during the election commitment. Yes.
Speaker 2:Said it right to my face.
Speaker 1:October, 2023, the minister decided that yes, Pompe Disease should, should enter the HTA process. It was referred to Sac <laugh> effectively 18 months ago. Yeah.
Speaker 2:But I , I wanna take it two steps . 'cause this is why it's so egregious that they keep using that. So when, when the department did their initial, let's consult with people about newborn blood spot screening and really tried to ask all these questions that said about ethics and risk and risk. And we shouldn't. And we shouldn't. They were more like, you know, tell us, no, don't tell us. Yes, that was fine. And then they said, what we're gonna do is we're gonna triage. We're gonna triage the ones that we look at first. We're gonna do them in three clumps. Pompe missed out on that first group. There was no intention by the department or the minister to actually look at Pompei in this first round of 15 that are currently underway and that we're still waiting for. The outcome for it is only because Better Access Australia and Australian Pompei Association totally lost their in the media and said, how dare you. And full credit to Raymond who said, the Prime Minister promised me he used Pompe as an example. He can come and see me and explain to me why Pompeii isn't even on the first round for consideration of having a dossier put together to con to look at. I, I find it absolutely egregious, but I also, it also goes to, in this space, the lack of political will by the minister to implement this and the ability and the confidence of the bureaucracy to set aside an election commitment. 'cause they don't think he's gonna push on it. If Raymond had not had the courage to, to make those public statements, I don't even think what BAA did would've helped. It took a Pompe patient to turn around and say, you stood there. You used us as the example, the Prime minister, and you just, you've literally pushed us to the back of the queue after we are the ones that started this. We , the Pompeii were the ones that came with BAA to advocate for
Speaker 1:This. Well , Raymond's been on this for 10 years.
Speaker 2:He's the reason I started BAA .
Speaker 1:Yeah. I mean it's a , it's, and now it's not. It was referred to SAC 18 months ago. It's gonna be considered in April, which means that May Yeah. May, which means there's no prospect of it being included until 2026 at the earliest.
Speaker 2:Well, I I think the only four years after
Speaker 1:That .
Speaker 2:Oh yeah. Unless there's a change in policy and you know, we'll, we'll we'll be begging who gets reelected and you , if the , if the coalition or whoever gets in, we , we need , you need to take a different stance on this and you need to do it differently because the original model we put forward, these would've been done unlisted . Oh . But I, I am really concerned. And so we can only be grateful that Senator Rustin continues to, to prosecute And I say prosecute this in the Senate estimates hearings, because otherwise no one else pays attention.
Speaker 1:Yeah. So let , let's 'cause what's interesting is that , because you always said they should set up the M sac review group. Yeah.
Speaker 2:We asked for an n task
Speaker 1:Task force . They're using , they're still using that task force group. Yeah . 'cause they used them on the Medicare items for the um, uh, the women's health package. Yeah. So they confirmed that at estimates last week .
Speaker 2:Exactly. And so we asked for that. We , uh, costed based on that. We talked to people within government and within both sides of , uh, the parliament about how that could be done. Uh , we spoke to clinicians about it. Everyone was fine and happy to do that. And then of course, as soon as they elected the , the bureaucracy got a hold of it,
Speaker 1:You could see it's straight away . That's not how we do it. You could see it straight away . It's so
Speaker 2:Complex and just 'cause it's, oh , the NRP is complex too, but to
Speaker 1:Have an evidence-based approach
Speaker 2:And it, it's, it's like we've had an evidence-based approach to actually transforming MBS item numbers. So we could have done this. And this is a very classic example and I think the pharmaceutical industry sees that if we wanna slow something down in the bureaucracy, we just give you a really good review process to make that happen. And that's exactly what happened with HTA and what is going on with that. And the five years it'll take for a patient's input to be evaluated for including in the evaluation. So
Speaker 1:As I said, the HTA review process is like two old people trying to set the timer on a video recorder.
Speaker 2:Yeah, no, I completely agree.
Speaker 1:It's like , it's just painful to watch for everyone.
Speaker 2:Meanwhile, we could just, we've gotta ignore it and get on with life. Um, so we talked a lot about , um, the estimates in respect of the contraceptives, but I'm not sure if you saw the announcement yesterday from , uh, pbs.gov au about , um, oh, by the way, if you show up with your current script, it doesn't work. Uh , and I've seen some people on LinkedIn, particularly those in market access or former former market access going, hang on, what do you mean? I , we , we now show up to the pharmacy and they're like, the script doesn't work. You have to go back to your GP of course to get a new script with a pb s subsidy.
Speaker 1:Ah , because it's not a PBS script.
Speaker 2:Yeah. So, and it's interesting. Some of the people go , oh , where , you know, why isn't it being grandfathered? I I want to , I want to actually talk about a few things in this. First of all, grandfathering, this is predominantly used in , uh, the oncology space. So it's very easy to grandfather and move people over. Most patients won ever see that because it's being managed by the hospital. A lot of the people who are going , why didn't you just do this? Don't see that doctors and hospitals just make that happen from the next change date . So you are already in there with your, your treatment pathway and the , the hospital pharmacy works at the doctor and it , it's, it's relatively seamless. So suddenly you are previously paid for moves over to being paid for. What the PBS system doesn't allow for is, you know, when when you get PBS subsidy, there's an item code on there. That's actually what also gives the pharmacist the right and authority to claim a subsidy. So they claim that you pay your benefit and they claim the difference. They , they pay the gap payment <laugh> from , uh, the , the government. Now the problem is that you can do that on things like we've seen it for the hormone replacement therapy shortages. So, but that's different. That's about supply shortages. So there's a specific piece of regulation, which is the national health Pharmaceutical benefits, pharmaceutical substitution of medicines with a prescription during shortages 2021, which continually amended to say, if I've got a shortage of one medicine. Yes. And it's already got that an item code. The , the pharmacist doesn't have to ask for a new script. They can substitute, annotate that on the script and then claim the subsidy. So the system works for that as long as the TGA recognizes it as same bang , same buck , um, you know, clinically substitutable. But there is a real issue, which is a script written for a private script does not have the information on it that makes it a legal script for the claiming of a subsidy. Well, PBS
Speaker 1:Script's a legal document.
Speaker 2:Yes. So here's the , here's the kicker. So the minister announced that he expected this listing would benefit 50,000 patients. So for 50,000 patients, majority of women who have a contraceptive script, it's a 12 month script. 'cause that's one of the good things. You only have to get the doctor once a year to get your script. It's 50,000 if a , if a doctor does four patients per hour, eight hours a day. That's , uh, 312 weeks , uh, in which to actually write all these new scripts. So obviously why we needed 50 new more urgent care clinics.
Speaker 1:Oh , we need to talk about that
Speaker 2:<laugh> . So , uh, unfortunately this is, when we talked about this illuminating stakeholder discussion and stakeholder meeting, this is something I'm a little bit surprised about, that no one forewarned the minister or the stakeholders about it is actually quite an intractable problem. Unless there is gonna be deal done and a new regulation written that says that a pharmacist can override it , write it with the , the , the item code, which is a fairly significant , does the law allow That doesn't at the moment. Um, you know, there's all sorts of things you can do under regulation, but this is something that is quite a common problem on the PBS. And in fact, a lot of people go from having their scripts suddenly being private to public and have to do this all the time. They have to go back to see their clinician and get a new script. Um, so people suddenly finding shock horror at it. Um, haven't spent a lot of time in the community pharmacy space. And normally, like as officials you are , you are always worried about how long it takes to get into somewhere. So getting into a specialist, it's like , we don't like medicines to be delisted too quickly because you've gotta get back into your specialist to get a new replacement medicine. But yet this, this was a very, very foreseeable problem. Um, and like I said, you are gonna have this crunch point. 'cause if all 50,000 women decide that they wanna stop paying full price for their , uh, current contraceptive, then yes, they're all gonna have to go back to their GP. And they are going to , um, actually have that sort of a both queue cost , um, and burden on the system. And like I said, options that could become, come as a solution, which the minister could ask the , the department to look at, would then cut GPS out of the loop again, which would be that GPS do get to bulk bill for actually meeting you to write a script. And a lot of them will even just charge you the fee to write and adjust the script
Speaker 1:And the law changes . It's a gonna take a while .
Speaker 2:Well, it's, it's, you , you'd have , you could potentially see whether you could, you could do a regulation that allows for a one-off on this. But then if you do that, you're gonna have to do that forever for all new private scripts that are then suddenly , uh, a subsidy scripts and they're not gonna do it. So doctors could
Speaker 1:Reach out to patients, couldn't they?
Speaker 2:Well, and they do a lot of, one , a lot of , um, pharmaceutical companies, particularly when it's a new on patent drug, are very good at working with usually specialists and some gps to say, this has changed. You might want to recall the individual in, but like I said , a lot of gps just do that automated. If you need a new script , um, and it's a , it's a script of the same , uh, item that's already been things, then they just charge you like $45 and they , they issue it. So a lot of people , you know, they do charge for the , for the , the service. But it is , um, I, I think I , I find it interesting because there are a lot of people online going, oh my gosh, why didn't they just grandfather? And that's not understanding how community pharmacy works and actually how grandfathering of private
Speaker 1:Versus public script works . Yeah . Well , the PS script is a legal document. It is. So it entitles, it gives certain rights <laugh> to certain people Yes. On that do document that the patient has a right and that pharmacist has a Right. Yes. And, and that's, that's not readily modifiable as you point out to the, the one where there's a substitution issue where there's a shortage. That was a law that went through the parliament. Yeah . In the context of the Well , it's , it was a pandemic, wasn't it ?
Speaker 2:It's just a regulation. Yeah. It's, it's the , it's still part of the National Health Act, but yeah, it allows for medicine shortages. Yeah . And , and actually making sure that patients don't have to go back. It's really interesting one, but it's one that sort of, when people are calling for immediate action, you also have to understand that if you, if you change it on this, you will change it for everything That in the future goes from being a private script to a PBS subsidized
Speaker 1:Script. And that's, you have to think about that from a policy point of view. What's might , might make sense today might not make sense six months down the track,
Speaker 2:But I think it's also going to be a tension point given that , um, you know, R-A-C-G-P is a bit concerned about these further urgent care clinics. Wow . And it also ties into the fact that, again, I've been caught in a , a fair bit of fewer about my support for PBS prescribing by pharmacy for contraceptives. So you
Speaker 1:Don't have to do that . Well , I dunno why you're get into fights on LinkedIn and it's just the most pointless exercise <laugh>
Speaker 2:I look, I I do not enjoy LinkedIn. And when I leave BAA , I'll be very excited to , uh, not perhaps be engaged there anymore. But I do think it's because that's where so much of the industry has their conversations. Um , and unfortunately they don't listen to your podcast Paul sometimes what it , it's important to actually have,
Speaker 1:We just had a very significant milestone.
Speaker 2:Those count those contrary views to broadening the thinking. So I , I do see it as my job in , in my volunteer role to say, no, I think we need to think about things differently. And unfortunately a lot of the medical and industry in pharmaceutical sector focuses their time and effort on LinkedIn. So that's where you kind of have to be,
Speaker 1:Can we talk about these urgent care clinics?
Speaker 2:Sure. Well , we need them urgently. Now just to rewrite 50,000 scripts,
Speaker 1:How are the doctor groups allowing the government to fund competition? I mean , we both , we've jokingly said that if they tried this on pharmacy, the pharmacist would turn Parliament House into Gaza. Yep . <laugh> . And I'm only half joking on that . <laugh> it , well , we were on 60
Speaker 2:Day
Speaker 1:Script. It would just be a moonscape. It would, I don't understand how this is a solution. This comes a week after that $8 billion announcement, right ? Yeah . On expanding the bulk billing incentive, which isn't good policy. It's
Speaker 2:Very bad policy.
Speaker 1:It's, it's, it's, I should not get bulk billed
Speaker 2:Policy . Now if you engage on LinkedIn, you'd know that this is what I was saying. I
Speaker 1:Should not get bulk . I should ,
Speaker 2:I specifically said Paul Cross should not get bulk
Speaker 1:Billing . Should not , I should someone like me. I mean, it's not like I'm private jetting it , but I don't, I I I shouldn't get a subsidy. That subsidy should be directed to concession cardholders families and , and people who really need government assistance.
Speaker 2:I completely agree. So
Speaker 1:Not people who don't need it.
Speaker 2:Yeah. And so at BAA we , we are saying that just like copays need more than two , um, you're concession or non concession. And there needs to be a midtier. And we, we believe this also in respective subsidy for the MBS , which we think would also , uh, free up , uh, acts , acts of money to provide access rather than actually giving the same amount to everybody irrespective of capacity to pay. But getting back to this issue on the urgent care clinics, the release of the $8 billion last week , and you know, we'll give you an incentive to bulk bill , fully bulk bill your clinic. And I watched a number of gps be interviewed saying, look, thanks for the extra money to try and help us give services for free to the patient. But I can't become a full bulk billing clinic because that 15 minute fee does not cover not only my services, but my admin services, the same cost of living that everybody else has got with electricity and consumables. I, I can't afford to deliver that service. I mean, I'm sorry. I think a doctor's value is more than $60 per 15 minutes noting everything else that comes behind them. And I think this urgent care clinic where the average that they're paying is considerably more because they're, they're , they're underfunding. The, the many of the ancillary services that are actually going to the cost of, of clinics, private clinics, we're going to lose our private gps. We're going to lose those who are running their own business.
Speaker 1:I'm a apostate, as you know, on bulk billing. I know. I , I dunno why general practice has supported it for such a long time. I think it's been, it's commoditized general practice. And I don't think that's been a good outcome. I think the incentive as, as it was announced and implemented 18 months ago was working as intended. So more gps were bulk billing concession card holders and families and they were charging others more. Yes. Out of pocket . I think that's a good, I think that's a good outcome. I don't think we want a system like the NHS where it's free a point of care No . For everyone. I think it's a very bad idea. And where that ends is the NH s where no one gets care effectively. Mm-hmm . Takes two months to get cancer treatment. Mm . I don't think we want that. We actually need a system that is means tested . That's what I'm saying . So we protect people who need protection. Mm-hmm <affirmative> . And people who can afford to pay pay. Yes. I think that's how it should work.
Speaker 2:With proper safety nets, with
Speaker 1:Proper safety nets. And then general <laugh> , these doctor groups, they're so polite and well, you know, interesting the RS RSPs announcement today, it was very polite. We were a little bit concerned because these think places aren't , don't seem to be operating all that well. It costs $200 a visit mm-hmm <affirmative> . It's costing the government 200. Well of course it's government costing the government a thousand dollars a visit because that's how government operates. It's not efficient. I don't wanna sound like Milton Friedman here.
Speaker 2:Oh ,
Speaker 1:But go on. But I don't think, I don't think, and you know, I know you're not allowed to talk about criticized bulk billing, but <laugh> , when I was incoming , we were trying to get rid of it . I mean, that was a long time ago. We were just letting her die. And then because it was seen as you c if, if we accept that people should get to see a general practitioner for free. How do we have PBS Copost mm-hmm <affirmative> . If we accept that people should see a GP for free. Why does it cost $500 to go see a specialist? Mm-hmm . Say we just have this one part of our system where everyone should be able to access it for free. And I don't think that's a good idea. I completely
Speaker 2:Agree
Speaker 1:With you . And it's, it's been terrible for general practice. Yes. Absolutely. Terrible for them. It's commoditized what is a very wonderful and , and, and honorable profession. And plays an incredibly important part in everyone's life. And it hasn't been good for them .
Speaker 2:It hasn't. And you know, as I've talked to you about, you know, I see that the increasing role of , of pharmacy and their , their respect for them as a clinician is very important because the complexity of primary healthcare is getting greater and greater. And there are some things that can be dealt with at the point of service in an immediate environment. Like I said, if we , if we trust a pharmacist to provide , um, uh, post, Post-coital contraception, so the morning after pill, if we trust them to an emergency, why shouldn't we be trusting them for UTIs and contraception in general and uh , support for, for minor skin ailments, et cetera . Because it's the point of care. I can get in and I can get into at 11 o'clock at night when it all goes wrong or nine o'clock and on a Sunday morning. And I don't live near an urgent care clinic. So I can get that treatment whoever I am, whatever I need. With the increase in comorbidities, the , the need for better diagnostics and , and through life planning, that is the role that GP should be in. GP should be the point of coordinated care. They are the linchpin for going, sending you backwards and forwards to specialists for diagnostics, for managed managing complex primary healthcare . 'cause we're doing everything we can to keep people out of hospital, but we are charging them a fortune to see specialists. Yeah. And we're devaluing of a GP saying, you've got 15 minutes to work this out <laugh>. Like otherwise we'll let you charge an extra $30. But I generally, if, you know, if, if you look at the kind of care people need these days, they need a half an hour. They don't need six or minute medicine or 15 minute medicine. And by saying that we're only gonna allow these charges, we are completely devaluing the complexity of that coordinated care role to sit and look through your records, to sit and look at what came through from the specialist, to be able to look at the medicines that have been coming backwards and forwards and look through your electronic health record . I think they are going to be the gateway to primary care. But they are not demanding from government that they are recognized by that in order that they are funded. And they have literally become, they are no different than a medicine on the PBS. The system sees them as I buy x million dollars , uh, x million services from a GP a year and that's how much it costs.
Speaker 1:That's Well, that's because we don't have a health system. We have a system of health financing. Yes. And , and that's how they've decided to finance Mm . This particular area of primary care. And it's, and it's not working. No . And so that $8 billion, great to put it , $8 billion into health, I'm all for it. But I think that could have been, that could have been invested far more wisely than trying to expand a bulk billing incentive to people who, who, who are not by and large, avoiding doctor visits because of the cost.
Speaker 2:No. And I don't think until it , it becomes very hard for organizations like better access to, to have these conversations when the main protagonists R-A-C-G-P and a MA just accept it . 'cause that's the money. They , they , they're so frightened of having the more sophisticated conversation. Yet if I talk to local gps, people who aren't, they're members, but they're not pol , you know, advocating members of the system. They all talk to you all the time. They're , they're furious at this. They're saying, you know, you could give me some money to stay open later to service my community. You could, we could fund this, this practice differently. I still need to charge people out of pocket because that's what the cost of the service is. But we could do this differently. And instead of opening 87 new clinics, we could be providing those services late at night or we could be providing them with more care , um, and time.
Speaker 1:It's one of those, one of those , uh, situ realities of our health system that, you know, you can't dispute. You can't dispute that everyone should be bulk billed . You know, you can't possibly argue that private health insurance should be able to insure people in a primary care setting, which is just the most ridiculous. So everyone should be denied. So
Speaker 2:You can see why I'm getting beaten up on LinkedIn this week. I've done everything you're not allowed to, to
Speaker 1:Do . It's ab it's absolutely, there are so many SHIs in this system that needs to be brought down. Mm-hmm . And yeah, you are an , an apostate if you argue that bulk billing needs to be targeted to those who need it. And that private health insurance should, should have a much broader role, including in general practice here . And why? Because it would make the product more , more attractive, more people would come into it and more money would go into to primary care and general practice. Yep . How are they bad things? Mm-hmm . But, but you're not , you're not allowed to argue those things. So it's, it's not been a great Whitefield policy, I would argue. And that would not be the, you know, most people would argue politically that, 'cause the coalition obviously think they're doing pretty well in the poll . So they're just tacking like it's a yacht race. They tacked again today on I think the cap 1983 . I I Why, why is the government setting up GP clinics to compete with the private sector? It just makes absolutely no sense. And for general practice, another 50 of these, well then is there gonna be another 50 after that and another 50 after that? Is the goal to have one in every electorate? What if you, what if you're a primary? What if you're a doctor's, a GP clinic, you've got a couple of gps, you've got, you own the building. You , you've invested all of this time and energy in building this business and the government opens up GP clinic , GP clinic up the road. That's,
Speaker 2:You need these things. They're called pharmacy location rules. Yeah . You need , and you should actually talk to the guild way , have protect yourselves .
Speaker 1:Yeah . I think that's, anyway ,
Speaker 2:It's
Speaker 1:Absolutely, I just can't imagine pharmacy. But anyway, I still think my comparison between the conquistadors and the Aztecs <laugh> is, is a , is a good one. Who's who in that situation. Well
Speaker 2:That's something hopefully your listeners will give
Speaker 1:You feedback on throughout the week . We can take a poll too . And I always say, I , I think, I think
Speaker 2:You should definitely run a poll .
Speaker 1:I think the government were the , I think are the Conors because the Spaniards had the guns <laugh> . And I think that's, that's , uh, telling, that's apt. It is very , it , it's , it's very telling. Thank you Felicity. Thanks
Speaker 2:Paul.