Defending the PBS at all costs? Critics say it’s time to stop hiding behind a failing system

At the G20 summit in South Africa, Treasurer Jim Chalmers took a hardline stance, declaring the government is “really clear that we’re not prepared to negotiate or diminish or weaken the PBS in order to get a [US tariff] deal.” But as Australia clings to its proud defence of the Pharmaceutical Benefits Scheme (PBS), a growing chorus of stakeholders is asking a pointed question: What exactly are we defending?

Australia exported A$2.2 billion in pharmaceutical products to the US in 2024 – 38% of all its pharma exports and 0.4% of total goods exports.

RACGP President, Dr Michael Wright, said “As GPs, we know our patients can’t and shouldn’t pay the price of US-style healthcare. The PBS means when we prescribe the treatments our patients need, we know they will be able to access them at an affordable price.”

For four years, stakeholders have been pushing for a serious shake-up of the Health Technology Assessment (HTA) system to make it fit for purpose in a world of precision medicine and rapid innovation in health technologies.

“We are all happy to defend the PBS but let’s make sure it’s worth defending,” said Richard Vines, Founder of Rare Cancers Australia. “Why do Australians wait years to access medicines that are available in other advanced economies? In the last 12 months Kate and I have paid out more on her cancer treatment than the Australian average annual salary.”

Clinicians, too, are frustrated by the opaque and often inexplicable decisions made behind closed doors. In the case of J&J Innovative Medicine’s Darzalex (daratumumab), Myeloma Australia’s Medical and Scientific Advisory Group (MSAG) flagged a lack of transparency and clarity around how PBAC decisions were made.

The PBAC’s initial decision to restrict reimbursement of Darzalex only in combination with Velcade (bortezomib) and dexamethasone for relapsed or refractory multiple myeloma lacked specialist endorsement. While the move appeared to be driven by cost containment, the absence of transparency left clinicians questioning the rationale.

Two years later, in March 2025, the PBAC finally recommended Darzalex in combination with Revlimid (lenalidomide) and dexamethasone for newly diagnosed patients – but only with a price cut and risk-sharing clause.

Despite these cracks in the system, Canberra continues to stand by the PBS even as the HTA Review report flagged critical gaps in access, transparency, and timeliness.

Dr Monique Ryan MP, the Independent Member for Kooyong and a paediatric neurologist by background, said “The US pharmaceuticals industry is furious because our PBS forces them to negotiate on medication prices. They are pushing Donald Trump to punish us because we have a government which has advocated effectively on the people’s behalf.”

Dr Ryan continued, “Changing Australia’s medical system to be more like the US would also delay availability of generics in our market which would keep the price of drugs higher for longer. The government has to defend our PBS…because healthcare should never be a bargaining chip. It should be a right.”

While the US tariff narrative continues to fuel ‘noise’ and uncertainty, it is critical that protecting the integrity of the PBS does not come at the expense of progress. The urgency of implementing the HTA Review recommendations cannot be sidelined. Patients awaiting access to life-saving and life-changing therapies deserve a system that is not only principled, but agile and responsive to their needs.

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