Government considers new PBS fund to slash wait times for treatments
The Albanese government could set up a new fund to provide high-value drug treatments awaiting PBS subsidy as early as the next budget.
The Albanese government could introduce a new health fund by the next federal budget to bankroll treatments awaiting subsidy approval as part of the most significant reform to the drug access system in 30 years.
Health Minister Mark Butler will be asked by a government working group to consider a Pharmaceutical Benefits Scheme bridging fund, which would subsidise access to new treatments with high clinical value before they were granted or denied entry onto the PBS.
Stakeholders have suggested it could support 7200 patients a year, highlighting recent breast, blood and lung cancer treatments that could have been eligible.
A communique by the Health Technology Assessment Review Implementation Advisory Group outlining proposed changes to the PBS suggested Mr Butler consider the need for a bridging fund.
The implementation group’s leader, former PBAC chair Andrew Wilson, told The Australian the group, after consultation, would recommend Mr Butler consider establishing a bridging fund by 2027 and expected major reforms to the PBS within this term of government. He would hand up a roadmap for potential changes in January.
“The minister wanted to see that substantive elements of the recommendations were either addressed or substantively under way within this term of government,” Professor Wilson said.
“We have brought forward consideration around bridging funding … and we’re suggesting to the government that it’s a matter that they should really try to finalise.
“Given that there are things here which will have budget implications, that means the 2026-2027 budget is the most likely point at which this would be considered by government.”
Mr Butler remained coy on his plan for the PBS.
“The (implementation group’s) final report is due in early 2026 and will help inform future government decisions on HTA reform,” he said. “We know patients want faster access to cutting-edge medicine and treatments.”
Analysis by the Bridging Funding Coalition, a consortium of patient groups and pharmaceutical companies, suggested 21,600 patients could have had faster access to therapies if bridging funding was available between 2022 and 2025 at an approximated cost of $334m a year.
Drugs granted the interim support would need to display high and unmet clinical values for time-sensitive illnesses.
The BFC analysis found 18 drugs that fit the description, including treatments for breast, ovarian, blood and lung cancer.
There was an average 815 days’ wait between each drug first being deemed safe and effective by the Therapeutic Goods Administration and being listed on the PBS.
It would be a complex undertaking, Professor Wilson said.
“You’ve got to decide what you’re going to provide a bridging fund for, you’ve got to decide when that bridging fund would apply, and you’ve got to agree on a pricing framework … when you haven’t actually negotiated the (drug’s) cost-effectiveness,” he said.
“But realistically in the two years that we’re suggesting, it could be developed and implemented.”
The lobby group, led by pharma giant AstraZeneca, has been leaning on the Labor government since November last year. A bridging fund was floated in the Health Technology Assessment review, which first prompted Professor Wilson’s work.
“Bridging funding could provide faster and fairer access to therapies for Australian patients who do not have time to wait,” AstraZeneca country president Ben McDonald said.
The PBS, which subsidises the cost of some drugs, is a scheme worth almost $18bn providing 930 different medicines at a universal discount rate to Medicare cardholders. Its last overhaul came in 1995 under then-prime minister Paul Keating.
The HTA review promised that with the institution of 50 recommendations to the PBS, the Medicare Benefits Schedule, the National Immunisation Program and the Life Saving Drugs Program, it could slash wait times on new treatments by an average of 16 months.
Newcastle mining training co-ordinator Cassie Bath was accepted onto a drug trial after a breast cancer recurrence. Across six years of on-and-off treatment she has continued in her job and says she would have been left financially imperilled had she taken on her treatment costs out-of-pocket.
“Every month, we’re living pay cheque to pay cheque with my monthly wage,” Ms Bath, 39, said.
“It can be difficult, especially with the amount of medical appointments that I need to get my prescriptions. I probably budget about $300 a month just on doctors’ visits and prescriptions for side effects.
“It’s just not viable for our situation financially for me to stop working as well.”
Ms Bath is the primary earner in her household, supporting her husband and eight-year-old daughter.
Medical oncologist Deme Karikios said bridging fund negotiations for high-efficacy drugs could provide an early opportunity to thrash out a pricing agreement between companies and the government.
“They can come to an agreed price that the company sees as reasonable and the government sees as reasonable, and it doesn’t have to be perfect because afterwards through the PBS process it can be renegotiated,” he said.
“What this does is allow a patient that would be fit for that medicine to get access to it earlier at a price that’s much more reasonable. They’re getting better outcomes and not suffering severe financial obstacles.”
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