Patients First PBS
NEGOTIATING BETTER ACCESS TO MEDICINES AND HEALTH TECHNOLOGY FOR AUSTRALIA
The Government is commencing negotiations with the medicines sector on the future of the community’s access to the Pharmaceutical Benefits Scheme (PBS), Life Saving Drugs Program (LSDP), National Immunisation Program (NIP) and other health technology subsidy programs. It is doing so without patient input.
The Government and medicines sector are already sending signals that pricing of medicines is the priority in this negotiation, and that savings measures must be delivered to fund the innovative sector’s Health Technology Assessment (HTA) review outcomes.
Better Access Australia wants a return to the first principles of Medicare – ACCESS. We want proposals developed by patients and community groups to be formally considered in the negotiation process.
We want a SEAT AT THE NEGOTIATING TABLE.
In introducing health technology assessment and the term cost-effectiveness into the legislation in the 1980s, the system has gradually eroded its core focus on the patient and made medicines nothing more than the bulk purchasing of a widget. This is flowing through to our access to medical devices and diagnostics.
Better Access Australia supports wise use of taxpayer funds, but the obsession with lowest price in this area of the general government sector, and in particular healthcare is without compare. As a result, Australians are simply not getting access to medicines and health technology in the primary care setting.
PATIENTS BEFORE PROCUREMENT
Perhaps the clearest example of this stalemate is patient access to biological medicines on the PBS. These medicines have been subject to multi-brand competition for 5-10 years and had prices cut of over 60%. The PBS should be providing earlier access to these medicines to prevent disease progression and disability. That was alays the promise. Yet today, in 2026, the PBS still demands that patients endure irreversible and permanent damage to their health before being allowed to use these medicines as standard of care.
As part of this agreement negotiation, it is time for the Government to put patients ahead of procurement starting with the following measures:
1. LEGISLATING FOR A PATIENTS FIRST PBS
a. Amend the National Health Act 1953 (NHA) to include consideration of patient health needs as the first role and responsibility of the PBAC.
b. Legislate a NHA requirement for the Minister to issue an annual Statement of Expectations to the PBAC aligned to the Government’s policy and health priorities, that is informed by patient submissions to the Administrative Review Tribunal, and Potential Preventable Hospitalisations targets.
c. Amend the NHA to set a maximum 10-year cumulative term limit for all PBAC members and a six-year term limit for PBAC sub-committee members.
d. Introduce a patients’ rights charter for the PBS and MBS to inform PBAC and MSAC decision making.
e. Amend the Administrative Review Act 2024 and other relevant statutes to allow patients to apply to the Administrative Review Tribunal for a review of PBAC and MSAC advice, and actioned by the relevant delegate that negatively affects their access to a medicine, medical technology or diagnostics.
f. Automate the PBS safety net and standardise the PBS safety net at 36-scripts for all.
2. DELIVERING ON THE PROMISE OF CHEAPER MEDICINES WITH MORE ACCESS FOR MORE PEOPLE
a. Lower the prescribing threshold for all off-patent biologicals. Specifically, allow use in mild to moderate forms of the disease they are listed to treat, based on the clinical assessment of the treating clinician without the need to have failed cheaper therapies, nor have degenerated to a point of irreparable damage.
b. Complete the PBAC’s post market review of all off-patent medicines to allow greater freedom in prescribing consistent with ARTG indications, or best clinical decision-making.
3. FOSTER A SYSTEM THAT CAN MAKE MEDICINES AVAILABLE SOONER, AND HOLD GOVERNMENT AND INDUSTRY TO ACCOUNT ON VALUE FOR MONEY AS A LISTING PROGRESSES
a. Set target of CPI or Health CPI for net growth for F1 medicines and vaccine investment on the NIP.
b. Provide increased funding of medicines for chronic disease on the PBS, recognising the Government’s commitment to 5% of all health investment being targeted at prevention, which modification of diseases such as diabetes, migraine, obesity should be recognised as a contributor to prevention of comorbidities and poorer health.
c. Using this same principle implement a strategy in both MRFF research and NIP funding to facilitate better access to vaccines for immunocompromised patients between the ages of 2-75.
d. Split the PBS into a community-based care and hospital-based formulary so that future negotiations on National HealthCare Reform Agreements and PBS medicine listings are better linked to outcomes achieved and costs within the hospital system. Pay based on performance on both sides of the system.
e. Establish a transparent Risk Share Arrangement framework that better balances risks between the Government (the purchaser) and the Sponsor (the Supplier) based on actual patient numbers and a more equitable sharing of risk
f. Make all advice of the PBAC eligible for independent review – vaccines, positive and negative recommendations, pricing advice.
g. Make the meeting agendas, minutes and advice from the PBAC Executive Committee public, as occurs in other comparable countries.
Better Access Australia also has suggestions on savings measures that could contribute to the cost of better and fairer access to health technology in Australia, in particular medicines.
We will be gradually releasing details on each of these areas of reform and our savings suggestions. The first two of these papers can be accessed here:
Better Access Australia welcomes input and feedback from the community and patient groups on these ideas, through either our contact form or email us at communications@betteraccessaustralia.org.au