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 'Dispatched' week in review podcast - 7 March
Medicines Australia will be appointing a new chair. To what extent does it matter? The participation model means that the industry might be effectively shackled to the 'change' table rather than having a seat at it. The government has worked it out, constantly increasing the price of participation and limiting exclusionary discussions about change. How does that need to change?
<silence>
Speaker 2:Hello and welcome to the dispatched Podcast Week in review. My name is Paul Cross. I'm delighted to be joined by my cohost Felicity McNeil, PSM, chair of Better Access Australia. Hi, Felicity.
Speaker 3:Hi, Paul. Happy Friday.
Speaker 2:Yeah. Friday.
Speaker 3:Mm-hmm . Long weekends here in the Great Brawl Camera bra .
Speaker 2:Uh , just to alert people that if you can hear
Speaker 3:The piece of pattern of Tiny
Speaker 2:<laugh> , it's, we're actually , uh, recording this at Felicity's Place, and she has very nice wooden floorboards, and my dogs have very big paws, and they make a bit of noise when they
Speaker 3:<laugh> . No , we are not rehearsing in the middle of a tap dancing recital.
Speaker 2:Looks like they've settled in to go to sleep, so hopefully it won't be, it won't be an issue. Uh , yeah.
Speaker 3:Text in and tell us your dog stories when you are on a Zoom with work
Speaker 2:<laugh> interesting times.
Speaker 3:Mm .
Speaker 2:Hey , did you catch any of , uh, Donald Trump's speech to the Joint Congress this week? I know it's not a , everyone calls it a, a State of the Union address, but it's not, but
Speaker 3:No , um, yes, it was, it was interesting. I, once again, I think we talked about him last week and I said, you know, what he wanted, which was to make Europe stand up and take responsibility for the war with Ukraine and Russia. In the end, it happens. Um , turns out they stand up, but only if Donald holds their hand , uh, and provides them the soapbox to stand on and funds it. But I, I did find it very interesting. I thought , um, people still don't understand. It's like that uncle that comes to Christmas and they can't tell when he's being serious about an issue that makes you shutter in horror or when he's actually having a joke. Uh , he's an an ultimate negotiator and , uh, salesman. He understands the pitch and he understands how to make people move. But I think what I found really sad is that Integrity comes from respecting others, even when the basis on which they say something is different. And I think that the way the Democrats ignored the women who were there, who had lost children being , um, victimized online , uh, seeking to educate themselves a 13-year-old trial with, you know, terminal brain cancer being acknowledged and loved and protected. You know what, in the end, you show your strength by knowing when it's right to actually applaud something that's being done and respecting everybody, even if they have a different opinion. And I think until people understand that, I mean, I'm the first, as everybody knows, to, to call that any side of government opposition if I think they're doing the wrong thing by patients. But I'm also gonna be the first person to acknowledge it and Right . And thank that. And I think the Democrats have lost sight in that , um, uh, forum about protesting to themselves instead of reaching out to the community.
Speaker 2:Yeah, it was, it was, it was out there. I was listening to the Two-Way podcast, which is hosted by Mark Halperin, and it's about the most balanced one you can get these days. He's a very long, longstanding American political journalist. He used to work at CNNI think for a long time, but he's excellent. He hosts both sides, and he tries to find the middle road. Mm-hmm . And he described it, it was like an MRI of their political soul.
Speaker 3:Wow.
Speaker 2:Yeah. It was, it was not good. I, I, I thought , I thought some of Trump's lines were just hilarious. I've not, his comedic timing is so good. When he was reading out the aid projects that they'd funded. Yes. And he talked about there was something for sedentary migrants, and he just said, nobody knows what that is. <laugh>
Speaker 3:Seated
Speaker 2:Migrants. And then he mentioned the program in the African Country of Latu . He said, nobody's ever heard of it, <laugh> . It was just, it was just, it was just, just, just so funny. So he's, he's got just this brilliant comedic time, which makes sense, because he did do that TV show for such a long time. But yeah, I thought the , the Democrats, I mean , they made a horrible mistake. I'm
Speaker 3:Gonna show my age 'cause I vaguely remember the advertisement he and , uh, Ivan Trump did on , um, pizza Hut deliveries. So
Speaker 2:He was in home alone too.
Speaker 3:Yes. <laugh> . So I think, and I think that's where sometimes we as interlocutors in different spaces need to not take the bait. Like people took the bait,
Speaker 2:He called them out at the start. He said, doesn't matter what I say. Mm-hmm . None of you will clap and none of you will stand. And then he, he baited them to do it, and then they did it. Mm-hmm . I was just, 'cause he just walked into the biggest trap. It was quite, it was quite, yeah. It was quite remarkable. But as I agree with you, the fact that they didn't acknowledge those mothers mm-hmm <affirmative> . And those harrowing stories and that, that that 13-year-old young man, he
Speaker 3:Ask the Secret Service if he could have a hug with me .
Speaker 2:<laugh> Medicines Australia is in the market for a new chair. And a lot of people have asked me to be
Speaker 3:The Chair of Medicines Australia, your magic . Wow. They get my Friday <inaudible>
Speaker 2:<laugh> . That would , that would not end. Well, a lot of people ask me, well , who do I, I think, and what do I think? And my answer has generally been , I , like, I really don't think it matters that much unless they sort of make a few changes in their approach. And I'm not talking about stylistic approaches. You know, the argument about aggression and appeasement completely misses the point that the challenge with the approach is that it's a little bit disconnected from government realities. People often talk about, well, it's a choice between the 2015 bans I charge and 20 17, 20 22 sort of acquiescence and an appeasement or agreement . And , and I would contend that they were both symptomatic of the same problem, which is a , a sort of lack of understanding of how government works. But, but the mode we've been in for a while is this prioritization of everything else I would argue of needing to be a participant, needing a seat at the table. Government kind of gets wise to that. They start jacking up the price of participation to the point where all you're paying for is to participate. And I would also contend that they're, now, it's not a seat at the table. They're sort of chain to it <laugh> . They , they can't get away because they're part of the institution. They don't really do any work outside the institution. And government controls their agenda by limiting what the institution can do. And you see that in the HTO review where the industry has basically had to concede everything and the government has progressed its agenda. So that, that, that to me is, is, is the problem, is that the obsession with part , and I'm not arguing against participation. I'm arguing against participating, understanding how government government works.
Speaker 3:So I think I agree with you. I think primacy to that part of the sector is participation. They , they believe that is the outcome that they're seeking. That if you are there, that's, that's tick. That's the win. Um , and like you said, they thought, obviously, I mean, you've been commentating, reporting, analyzing , uh, the industry's engagement with , uh, the health system and government in particular for what , almost 15 years now in one form or another. And even in the, the previous situations from 2000 and between 2010 and 2015, the concept of the power of participation and what a lever that was or wasn't. And then not not having that sense of history. And I'll gonna talk about some people's particularly impressive corporate histories and how they actually use that really intelligently. And I think sometimes people have a corporate history and they don't understand what the lesson was to learn from that. So they see it as all costs . And you're quite right. Since 20 , uh, 15, the obsession for 10 years now has been the primacy of the seat at the table and the extraordinary prices that the sector has been willing to pay for that seat. And the price, not only that they've paid financially in price cuts, which have obviously led to job losses , uh, reduced investment in particular parts of , uh, the, the not-for-profit sector, but the price that patients have paid because of those decisions of the primacy of participation. So the desire for all else to have a review that focuses on the discount rate and comparators, and putting forward recommendations that, you know , the first time a molecule comes to Australia, it , it's expedited through the subsidy system, disenfranchises 90% of people who need access to a medicine. So I think it has colored and done a huge disservice to the sector and to what they're trying to achieve, which is , uh, access reform that benefits patients as well as by default them. And you do, you do need different leadership that is willing to stop and reflect and see things differently and engage differently to , uh, embolden and strengthen and have pride in having a different opinion.
Speaker 2:Yeah. Well, the consensus is killing the industry's ability . The demand for consensus and acquiescence to that consensus is killing a lot of processes within the industry, but also policy processes and ultimately it's harming patients. Yeah. You know , I , I , I think the first priority has to be that if you're gonna put your signature to an agreement with the commonwealth Hmm .
Speaker 3:<laugh>, I know what you're gonna
Speaker 2:Say. At least understand what you're signing.
Speaker 3:Uh , yeah.
Speaker 2:And because people have lost their livelihoods over that . Hmm . And I'm not talking about industry leaders. I'm talking about sales representatives, people that work in clinical departments and medical departments, regulatory and market access people. I would contend that hundreds of jobs have been lost in the industry. Mm-hmm . And everyone sort of looks the other way. Let's just make sure there's no rewriting of history of what happened there. Mm . It was celebrated, it was negotiated and agreed without the detail, just the high level detail. Oh , we'll get to the cha The , uh, the catch up later, a month before a budget. Guess what? It was hidden in that budget. Mm . So they agreed upfront to price reductions without knowing the detail. And then went into a negotiation with absolutely no leverage. They actually had a lot of leverage in that price negotiation. 'cause the government needed their agreement.
Speaker 3:Yeah. And they had a current one.
Speaker 2:Yes.
Speaker 3:There was no reason to be back at the table.
Speaker 2:And, and whilst they talk a lot about comparator comparators, they gave up the single biggest reform on comparators from the 2017 agreement. Oh yeah . 'cause the department simply refused to implement it. Shadow pricing.
Speaker 3:Shadow pricing was , they
Speaker 2:Gave up two years early. They gave up two years early. So, so that , that to me. And then, then when they were warned that they'd misunderstood what they'd agreed to, they dismissed it. I've seen the correspondence, I've written about it. And they actively opposed parliamentary scrutiny of the enabling legislation. And then everything turned really bad going into going into 2027, obviously the government is gonna land this HTA review and whatever tinkering they do into a new negotiation mm-hmm <affirmative> . It's plain as day. So for me, there has been this very dilettantish view of public policy around healthcare from the industries that it hasn't quite connected. And people are gonna take this badly. And that's, that's fine. Uh, someone's gotta say what everyone else is talking about. So there is that, there is that disconnect where the industry is now chained to this participation model. And the government limits instantly limits the conversation to what it wants to talk about. And where the industry has its agenda, the government just obfuscates on it and nothing happens. And that HTA review is a perfect example of that. And nothing happens outside that frame. There's virtually nothing, no bus, shelter, LinkedIn post. But they're , they're not gonna drive change at all. So this is, this is a , this is a real challenge. 'cause the industry does not have a disrupting culture. It tried it in 2015, and it didn't last 24 hours. It's, it , it understood in 20 20 15 that it was gonna throw a punch, but it never realized that government punches back. And once you cross that road, all bets are off.
Speaker 3:But I think it's also, they just thought that throwing a punch was all that was , would take one punch. Like it was like a technical knockout, like bang, we're done. As opposed to if you want to, when you choose to engage, when you choose to dispute and actually , um, disagree with your interlocutor, as opposed to just keep handing over the cash, you have to have more than a plan a <laugh> . And it actually has to be , uh, enveloped in and based upon significant policy development and ideas that you are bringing to the table yourself. It's why the Guild does so well, we talk about them all
Speaker 2:Yes . All the time. And I want to talk about them in the context of International Women's
Speaker 3:Day . Because, you know, as Trent has said at your conference, <laugh>, I can edit that out . So Trent has said at your conference, and many a time in the past, and as my experience with the guild, both as a bureaucrat and as a patient advocate, they're always planning 10 years. So everything that's coming to fruition is building, refining, adding to , you know, there's a reason the NIP is fully rolled out in pharmacy these days. There is, because that started in 2010, 2011. You know, there is a reason that we are going to have , um, subsidized medicines written by a prescribed by a pharmacist for the PBS because of the work that they've been doing in the state and territory governments for eight years to meet the gap in access to primary care. They're thinking about these things all the time, about their place as clinicians, and also what always the horse called self-interest. They represent small business owners. So they think like a small business person, they understand risk, they understand investment, and they understand opportunity. And they understand that every time you put your own dollar on the table, you've thought about where you spent it. I think the disadvantage at times for an industry that is part of some big huge global corporation, it's not your money. And so the analysis and the preparation that you feel you need to do is different. You do it on your individual products. Absolutely. Because that's the money of the
Speaker 2:Company. They're , they're very strategic on their products. Very
Speaker 3:Technically strategic, yes.
Speaker 2:But no, no. But on the , on the , on the development. Absolutely . I'm talking about OO over the life cycle of the product. These companies are incredibly strategic. They just need to lift that and apply it to policy matters.
Speaker 3:Yes. And, and I think, you know, stop thinking that the , the way you do things over and over again is, is working. 'cause it, it kind of isn't. And, you know ,
Speaker 2:Well , no , if you keep re redefining, I mean, if
Speaker 3:You keep redefining successes more , if kept more time at the table.
Speaker 2:Yes. Because this is , this is the problem with the , the participation model is that in order, 'cause the government keeps increasing the cost of participation and as I say , ultimately chain you to the table, you're constantly conceding. So you're constantly redefining what success looks like, particularly if you're a sector who fears nothing more than admitting that you're wrong. And so if you look at the guild model, they don't concede a thing. And the best example is their argument on patient copays. They have secured really positive outcomes on that, but they haven't redefined that as a success. So on International Women's Day, they issued a media release, and I just thought the guild wins again. They said women are t twice as likely to not have their prescriptions filled because of cost . So they linked it to the issue that they have been prosecuting for so many years now. Mm-hmm . So they're not gonna concede the principle. You saw that on the dollar discount as well. Mm-hmm . They said, okay, you can put it in the agreement, but we don't have to agree to, we don't have to agree to it. Mm-hmm . 10 years later.
Speaker 3:Yep .
Speaker 2:It's on a five year path to abolition. So 15 years, they never, ever, ever concede. But they're constantly supporting, they're constantly applying pressure externally to the discussion they're having within the institution. And I think the industry could learn a really important lesson from that, that if yes, you know, if you, if seat seat at the table, by all means, you are not disruptors. I mean, I often talk about what we were doing in Washington during the US Australia free trade agreement. It was nasty and it was aggressive. And if the leaders here knew what two or three of us were doing, they would've put a stop to it straight away . But, but the disruption delivered positive benefits.
Speaker 3:Yes. Which are largely,
Speaker 2:Which the industry, he can't concede
Speaker 3:<laugh>
Speaker 2:<laugh> , which , which they , they can't concede.
Speaker 3:We , we can only hope.
Speaker 2:But, but, but to me, that that's the lesson. So whilst you are having those discussions, because you are not instinctively disruptive, and you see that in the campaign around 460 days. So what, why don't you tell us how many people are dying as a result of their 460 days? That would actually put, they're not gonna , they're not gonna do that though, because culturally they're just not built to get in a political fight. But there are other ways you can pressure the system. There are other ways you can do it. Look at the great research they supported 20 or 25 years ago that ultimately led to the separation of the PBS into formularies. The most positive product friendly reform in the history of this system. But it was years in the making evidence-based, credible evidence coming outta Victoria University. I don't think it's called that anymore, but coming outta Victoria University and the Peter Sheen group who basically produced these great research papers on this is what's happening in the PBS with pricing. And it was credible Peter, she x set of treasury in Victoria. So they're still going. Those guys <laugh> , they're , they're still still working away. So that , that to me is, is where, where they could make a big difference. By all mean , by all means stay at the table, but do really high quality work on the outside that you can introduce to the political environment. But you can introduce via your participation model.
Speaker 3:Yes. Um, come , but also be prepared to stand on principle and that principle being something other than keeping your seat at the table. So it's not about, you know, running off and saying yes to the best PBS again. Um , but it ,
Speaker 2:Well, they'd have to come to me if they want that URL back.
Speaker 3:But <laugh>, we, we might borrow that from you at BAA <laugh>. Um , but you do need to have clear signals for government. Government does look for where is, where is the tension point where that is how good policy and program reform is done. Because you are constantly stress testing against these different stakeholders. What is actually doable, acceptable, a step too far. And if you are never, ever giving that signal, or when you do go, oh , it definitely won't list. Oh , definitely won't be this. Definitely can't do that. And then you do it, the system just says, okay, well you're not, you're not serious about this. But again, pointing to , to the guild, they , they're very clear that they, they, they are also reasonable. And I know people are gonna have a shock that I say that as a form of bureaucrat from that side of it, but they are very reasonable. If it's a step and a process and a , and gradually getting to that point, they, they will go with that. So I think at the moment, they're really pushing on the , um, uh, the principle of affordable medicines. Um , like I said, we agree that medicines need to be more affordable at BAA . We disagree on how it should be achieved. We think that the, the cheaper copay should be a mid tier one. And people who have a higher income should, should still be paying the 31 60. We think the relief needs to be in the midpoint. We think our health system has just got far too linear. And it's like you're either concession or you're not. And it doesn't recognize the nuance in , uh, the Australian community. And the , the degrees of which our capacity to pay for our healthcare , our disability services, our childcare does change as we earn more income. So this, this is what the weird thing about our health system is. It's, you're in or you're out. As opposed to our social services system, which titrates out now think you'll know we have a different opinion. They're fine with that. We have a common goal. The fact that we might slightly disagree on what the final goal looks like. They've, they're calm and they're rational and they understand, and we understand we're working towards an outcome. Whichever one it is is fine. But the the principle is good and consistent and they're willing to talk and they're also willing to work with government. And we say, not this, but this. They're like, yeah, we hear you. Okay, that's not working. We need to change. How can we help? That's why, why when COVID-19 rollout was a complete shamozzle, complete shamozzle , where did we all turn to? We turned to pharmacy to fix the problem. Pharmacy were the ones that would still open their doors and see a patient in person. And we learn from that lesson that they are willing to be there at all times, do all things because they take on the work and the experience and the training and say , let's, let's get this done.
Speaker 2:When it comes to the participation model, the opportunity is , is to support that process with some credible ideas. Yes. And that means investing in the ideas. And that doesn't mean comparative selection and the discount rate . It means really good public policy ideas, which is what the industry used to do. And not just, just not just on public health. You know, the industry used to spend a lot of time on an industry policy. Mm . Uh , I don't, I I don't see a lot of that these days. So I , I think
Speaker 3:Baxter did some work on industry policy for the industry
Speaker 2:This week . Yeah . They , they , well , yeah. Wow . 20 million. Uh , so, so I , I do believe that there is an opportunity because, well , I , I , I think it would be hard to argue that, that the current approach is working. There is an opportunity understand what your limits are as a sector. I don't, I don't think you should imagine for a second that you can do what the pharmacy Guild did on 60 day dispensing. Culturally you are not it. Even if you launched a campaign like that, there'd be 10 companies walking around Parliament House saying it's nothing to do with them. Because in the end, these companies have their own interest as well as the industry interest. And they don't always align. So the best way to do this is to, is to develop really good ideas to support your participation model. Hmm . Be because that , that is now very much a, a trap that works just brilliantly for the government, because you can't get away from that table. And as I say, I'm not arguing that you shouldn't participate. I just think you've gotta give yourself more leverage in that participation. And when it comes to government, that means presenting them with some really good ideas. Now, the other , the other tough issue is the real change. We saw this in 2006 with the form formulary split. We saw it in 2015. With that , the , the negotiation on the statutory price cuts is there are winners and losers in the industry. So you were never gonna have tho those negotiations in 26 and even your first one in 2010, you would've been involved in , I think mm-hmm <affirmative> . They were contentious difficult processes where there were winners and losers and there was no consensus, but they were good policy outcomes. And as a result, the industry built policy credibility. Acting like you're a division of the health department means that you are an enabler for them. And I don't think that's the way to go. Now, part of this, and I harked back to Wellington last year, the event in Wellington, it was just after the government, I think they weren't long elected medicines. New Zealand and the industry in New Zealand sort of created that platform. They gave it to the patients and the patients and the clinicians put on a fantastic, fantastic program. Clinicians speaking about the limitations, patients , Fiona talking about her own experience as a patient and why she had to move to Australia. It was incredibly powerful. But the industry gave it up. It wasn't the industry talking about itself, it was creating a platform. Now, are we there in Australia just yet? Probably not. But I do think when you look at what's happened in New Zealand, and look, they're coming from a long way back. They've got a lot of extra money. They've listed a lot of medicines, a lot of change in pharma act . So it's heading in the right direction. I saw Rachel's comments about that. They were quite funny. It's been disrupted externally.
Speaker 3:But can I also point to the learning on that, which was a lot of how New Zealand is, is because the industry let it happen in the first place. Agreed to
Speaker 2:It. Same as you .
Speaker 3:My point. So they , it happened, they kept letting it happen and happen and happened to the point that patients out of had to take matters into their own hands. Yeah . And the smart people and including the , uh, CEO of Medicines New Zealand Graham Yep . Realized that it wasn't about what he was saying and what the companies were doing. It had to be about what the patients were because the industry had had effectively given everything away. So.
Speaker 2:Well, those systems only exist because companies acquiesce to it .
Speaker 3:Exactly. And so the fact that there was a coming, there was a differentiation. There was a, a tipping point that had been reached in New Zealand and it's still appalling. Like I I read the , uh, US Pharma report of 2025 to
Speaker 2:The 3 0 1. Yeah .
Speaker 3:To , um, let , let me tell you everything that's wrong in every country. Yes.
Speaker 2:It's about 300
Speaker 3:<laugh> . And , and I did, I'm one of those SNAs who reads it. Um, but you know, new Zealand's nothing can , you know , to Australia apparently. But I do just find that's because it got to a point, and I don't want Australia to get to that point. At the moment, what happens, prioritization, exclusion of patients is because of the way the industry engages with the department and the way it prioritizes the, its relationship with the department and the department's outcomes over the patient voice. Yeah . And the patient need and patient patient control of a public health system. And we kind of need you all to, as part of your next iteration of change at MA in your leadership, you need someone that understands that perhaps we need to learn from New Zealand. Not just because we could be heading further and further down that path. Because the stuff that's coming outta the HTO review will affect the MBS and SAC as well. But because we should also understand that before it gets there, perhaps we should learn from what they've done and actually really empower patients to just be part of the system. And not just the usual suspects. Not just the usual groups, not the same people that sit at the tables. Just, it can't always be about you've been invited. You shouldn't have to be invited to be part of your own health system.
Speaker 2:No, well that's, that's the institution working against the people it's designed to serve. And, and I , and I, I don't think it's poor intent. I don't think the intent is poor. I just think people can't see it. You know, if you are , you can't change something if you can't recognize it. Correct. So, so this is why I think we need a lot of more new voices and more, you know, we've had the same people having the same conversation for a very long time. The pressure is building in the PBS. I mean, I liken it to, to, when we were talking about it yesterday, it was, it's like, it's like a bath where the tap is flowing, but it's not filling properly because someone hasn't put the plug in . Mm-hmm . So the government, the reality is the government is going to, it recently announced $8 billion for the Medicare bulk billing incentive expansion four years. I think that's, that expenditure is the government will invest around that amount in new PBS listings over the next four years. Correct. The problem is, it'll take about that same amount outta the PBS because of everything the industry has agreed to, all the statutory price cuts, the ad hoc, the administrative prices, all of the pricing policies that have come in, these are what the industry has agreed to. They've made some very serious concessions in 2022. They conceded the hard one principle of a single brand of medicine, the value of a single branded medicine by ag agreeing to that 30% price cut of 15 years and
Speaker 3:Relying on a ministerial discretion to overturn Yeah. And fight for you could , you had to
Speaker 2:Fight. So they ba basically conceded really important principles. I dunno whether they realize how important that principle is, but it was very hard fought into , you know, 20 years ago to win that. And I think that's a mistake. Virtually nothing happens in this system without the industry's direct or indirect agreement. Now, it's very hard to get around that because Medicine's Australia or the GBMA can say no. And then a company says yes. And it's policy. Yes . Because companies have different motivations. This goes to the competing interest. It's hard to reconcile that. But I think if as a sector you have a rules-based decision making framework, like the Guild do, there are some things we will agree to. And there are some things that we won't agree to. We cannot agree to these things. Now, it doesn't mean that you can't implement them if you can get the parliament to support it like 60 day dispensing. But we are never gonna agree to it. And I think on something like the single brand value as a matter of principle, why wouldn't you just say we , we , we can't agree to that. Not in any world can we do agree , agree to that. That's, that's, that's an ip. These are drugs that are , are either still on patent or are too complex or difficult to re replicate. So we're not gonna concede that value point. It doesn't mean you can't do it. If you can get the parliament to agree to it or a company to agree to it, you can do it. But we are not gonna agree to it as a matter of principle. And I think that's, that's how you start to win
Speaker 3:Principle space decision
Speaker 2:Credibility. And so I, I would hope that's, that's the path they can go down. I don't , I think the idea of public campaigns is it's just not in there . The one that they've been doing, I can't even remember , stronger PBS, there's just their heart's obviously not in it because it , it's, you're not, it doesn't, it's meaningless. You know, it's like you're not telling me anything. There's no call to action in there. And the thing is, while you are saying stronger PBS, we need a stronger PBS, we need a stronger PBS every month, four to five companies issue media releases thanking the minister for making a stronger PBS
Speaker 3:Oh . With the exception of , was it Eli Lilly that actually
Speaker 2:Put on that ? Yeah . They've , they've done it a few times. So it, look, it's, it's, I know it's really, really hard, but principles-based decision making and letting go a little bit pressuring, pushing patients to the front, letting them take the lead on these issues because they can be incredibly convincing and pressuring the institution from the outside. You can do both. You can be part of the institution and if the price of participation is being quite on the outside and you've gotta make a decision. 'cause I don't think that model's working.
Speaker 3:I don't think it's either for the industry or for the patients who are waiting for things. Certainly not. So , um, yes, I , I agree with you on the stronger PBS and that , that was one another thing I had a bit of a laugh about reading the Pharma 3 0 1, was that they're still asserting that it's , um, I think maybe they read our submission to , um, the novel technology inquiry, but that it's a , it's a 30 to 33 month weight for from TGA registration to , uh, subsidy on the PBS . That's what , but I thought perhaps it may , might wanna send in their latest campaign
Speaker 2:<laugh> , the HTA review said it was like two years mm-hmm <affirmative> . Because no drug that delivers it said it in 2021 and 2022, I think it was. No, no, no. New medicine that delivers a benefit to patients, a incremental benefit to patient was recommended first time. In fact , that took like , on average 22 months or something. Mm-hmm . So that's what , that's our world class system. Mm-hmm . Well, I I also just wanted to mention, I was talking to someone yesterday and they , they mentioned that someone is leaving a company they've been at with for almost 20 years. Someone I've known for a long time. Lisa Julian , who has done comms at Eli Lilly for that time. Oh yeah. And yeah, I've always had a lot of respect for her. And Lily's a company that generally does act on principle, it ref refused to list the biosimilar
Speaker 3:Insulin.
Speaker 2:Insulin
Speaker 3:In 2011. Yes.
Speaker 2:Which forced you to have angry conversations with the TGA
Speaker 3:<laugh> . I love the TGA
Speaker 2:<laugh> . Not at the time.
Speaker 3:So speaking of good women, what are you doing for International Women's Day tomorrow, Paul ?
Speaker 2:Uh , probably not a , not a lot <laugh> to be honest. I know. Oh , Saturday. That's not a good day to have it.
Speaker 3:Well, you know, we , we can't choose. Well this is the date we chose, but oh , could we just do a Friday? Oh wait, that sounds like a public holiday for Australia Day in
Speaker 2:Australia . Don't , I don't understand. Women only get a day. Biosimilars get a whole week
Speaker 3:<laugh>. So does Shing
Speaker 2:<laugh> . I don't understand that.
Speaker 3:Well, I'm pretty excited because Netflix heard the call and is releasing drive to survive in time for me for it to come out on a , on International Women's Day in Australia. So I'm very happy. It That's
Speaker 2:Right . That's right. That's what you'll be watching. No , I know. Those, those things are important as why I thought , I thought the guild absolutely nailed it by linking it to, and that's, I didn't realize that that's a terrible stat that women are twice as likely not to fill their prescriptions 'cause of costs . Which I am guessing means they're sacrificing for their families.
Speaker 3:Yes. And it's why the, the push in state governments to make women's healthcare available through community pharmacy because it's also the touch point and the ability to get in to , uh, a service and get that urgent medication as well. So it's, it's a , it's a double-edged sword. Uh, women's health is, is complex. Not because men's health isn't either, but some, some realities are still in place. And a lot of women are the ones that are juggling the budgets, working out what can and can't be done. And as women, we spend our life being engaged in the health system long before , um, a man needs to be. Because usually we're, we are there because of our , our teenage years. And from then on the way our bodies operate through, through life means we are constantly in there. Which means also the constant need for access to healthcare and healthcare products is much higher than across all women, as opposed to many men who have, have specific conditions. Just being a woman is expensive. And that's not because I like champagne.
Speaker 2:<laugh> doesn't help though, but it's, yeah, it's, yeah, it's an interesting one . I I think the linking of it to real bread and butter issues , uh, by pharmacy was very , uh, very impactful. I thought. Very impactful. And one, one thing I'd also like to mention is the Tix report released this week on nuclear medicine.
Speaker 3:Yeah, I saw that.
Speaker 2:I thought it was , uh, to say that Australian policy around nuclear medicines incoherent would be an understatement.
Speaker 3:I think they summarized that beautifully.
Speaker 2:<laugh> that , but , uh, I'm still completely flabbergasted by the decision to fund unapproved and unprovable products , uh, over so far, over an approved product. And the fact that one of Australia's greatest emerging life sciences companies, if not the best emerging life sciences company in TLX is, has been the bene beneficiary of industry policy over the years, including the r and d tax incentive , uh, is, is having to do this, ask the Australian government to enforce as regulatory framework. Uh, you know, you can't put put anything, the health system really is not meant to implant or inject or administer or give you any product without it being approved in some form by the TGA. But literally there's more oversight of vapes than there is of those nuclear compounded nuclear medicine therapies.
Speaker 3:And so it goes back to, and sorry to harp on it about , about being clear what your principles are as an industry organization. Mm-hmm . I would've thought this was like a deal breaker for the innovative medicine sector represented by Medicines Australia. I would've thought this is an ultimate, you cannot do this. I thought it would align with all of the strategic needs. I mean, a 5% price cut at five years after listing on the PBS is nothing compared to you're going to subsidize something that's not registered over something that has been fully invested, trialed, and submitted.
Speaker 2:Well , well let's, let's make a comparison. This is an unapproved and unprovable compounded product for which there's no clinical data. In fact, they use Novartis's clinical data to secure the reimbursement. Mm . So I don't know who's liable for all of the safety reporting adverse event reporting. They could fund that. What they won't agree to do is to fund immunotherapies through an accelerated or a brief truncated HTA process that have been approved for new indications. So these are products that would be considered by PBAC 35, 40 times each. And all they did propose was to amend the process so there would be effective, a quick truncated reimbursement process for every new indication. No , that's too hard.
Speaker 3:Yeah . And like the irony, which is we can't possibly race ahead to meet the election commitment of , uh, having a world class newborn blood spot screening program because we are really worried about the safety.
Speaker 2:The safety. That's right.
Speaker 3:A test of a diagnostic of a diagnostic that we're already doing doing . But we can, we can happily , uh, subsidize that's an unregistered , uh, nuclear product. Well ,
Speaker 2:We've been talking a lot about bad policy recently. I've got another example. Ooh . This is why , which , which is the , which is 'cause we're getting closer to election . So there's a lot of bad policy, but the minister's directive to health insurers that they have to take, use more of their premium increase, which is what 300% give it to private hospitals. And if they don't, he's going to, by June, he's gonna somehow regulate because this is just what private healthcare and Australian needs more regulation.
Speaker 3:What
Speaker 2:<laugh> Yes. Yeah. Yeah. So he's directed them to, I presume it's like, I don't know . I mean, I don't know what standing that direction has. I mean, in the end, the prudential regulator, I mean they do
Speaker 3:Well , wouldn't they also the prudential regulator be saying 'cause they're really strict rules on how you manage your money. Go . Well ,
Speaker 2:It's a , it's a fixed, a health insurance have a fixed pot of money. Yeah . So if they're giving more to private hospitals, they're giving less to someone else. Yes . Because their insurers, like 90% of what they get, they pay out. So you're saying they should cut their admin costs . The admin costs , which is payments to hospitals, payments, yes. Customer acquisition, when they need customers, all of those things like administration and Yeah. So you think it should come out of that. Okay. Or should it come out of other provi providers? I think it'd be pretty hard to adjust that. The admin cost and about 10%. So IJI just, it's a very, how would you regulate that in a , in a way that wouldn't kinda
Speaker 3:Sounds like a thought bubble, doesn't it? Maybe he's trying to do a , like election bubble Trump where he sort of says, you know, when President Trump said something and then everyone says, oh, cranky, we better go and do something about that. So maybe he's learning from President Trump and said, I'm gonna say something which people might think is outrageous to encourage this sector to go, Ooh , well we wouldn't want that. We better sort this one out ourselves. I don't know . I don't know . But yes, it's definitely , um, uh, it'll be good once the election is called so that, that we can see what's really going on and go through a bit of the silly season and then get back onto some good strategic long-term policy that benefits the community. That's
Speaker 2:Good. Thank you, Felicity.
Speaker 3:Thank you Paul . Thank you .