Sunday, 20 December 2015 16:58

PBS Listing - Heaven or Hell? - The Devil is in the Details

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I'm writing this to help people understand what the recent announcement that DAA medications for HCV will be listed on the PBS. Here are a couple of links to it, both with interviews with the minister: 

First let me say I think it's fantastic that the government has committed to listing these medications because it will make them more available.

You go girl!

The questions on everyone's mind, including mine, are "How much more available?" and "When?"

If you like executive summaries the answer is "We just don't know". We don't know because the key listing documents are not public and they are what will define access. The waiting is not yet over.

What follows might best be regarded as an informed guesstimate.

I have heard rumours on the grapevine like:

  • DAA prices ranging from $15,000-25,000 per patient,
  • 24 weeks treatment for the same price as 12,
  • Free medication for retreatment, and
  • A payment cap in that if enough patients present for treatment all the patients over the cap have their medications provided free (not all that hard given a production cost of $150 per patient).

So you could get all excited and think, hey, wow, if all that is true and the government spends a billion next year and that gets 66,666 treated and the overflow patients are free!

How good would that be? Too good to be true I expect.

Before you get too excited remember that the minister said $1 billion, and within a generation along with the "everyone will be able to have treatment".

She did not say "everyone will get treatment next March" and that would be practically impossible due to all the access bottlenecks.

A friend of mine told me, "If you really want to know what's going on then follow the money" and as luck would have it.....

Ms Ley said the PBS funding had been accounted for as part of Tuesday’s MYEFO, but was not announced until today due to confidential pricing negotiations with medicine suppliers

Hmm, never heard of a MYEFO but let's find it, trawl through it, and see what we can find. Ah ha, here it is:

Scroll down to the Health portfolio and you can read:

Pharmaceutical Benefits Scheme   2015/16 $m  2016/17 $m 2017/18 $m  2018/19 $m
— new and amended listings 112.1 150.7 165.6 181.8

 So given the minister said the expenditure had already been accounted for in the MYEFO, the $1 billion appears to represent spending over the next 6 years.

Assuming that the $15,000 cost per patient is correct (and this would be 3-4 times better than anyone else in the Western World has negotiated) we could estimate the treatment targets as:

Year Spending Patients
2015/16  112,100,000  7,473
2016/17  150,700,000  10,046
2017/18  165,600,000  11,040
2018/19  181,800,000  12,120
2019/20  200,000,000*  13,333
2020/21  220,000,000*  14,666

* Estimated based on the 10% rise we see between 2016/17 2017/18 2018/19

For your interest I've included an Excel spreadsheet that allows you to play with various scenarios around cost, spending and infection rates.

For everyone to have access our government needs to have pulled a rabbit out of the had and negotiated a payment cap. I really hope they have, and that when the medications are listed they are routine Authority items (so any GP could prescribe them), not S100 (meaning only a limited number of specialists could prescribe them).

For anyone who has paid for medications that have not yet been delivered, and would now like to wait and see, we will be happy to refund your money.


Read 105626 times Last modified on Monday, 21 December 2015 17:12

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