Lilly takes PBS access battle to the private market

Lilly is taking its battle over access and pricing beyond the Pharmaceutical Benefits Scheme (PBS), expanding its reach into Australia’s private healthcare market with the launch of a new online platform that gives patients access to medicines not currently funded.

The move comes amid growing tension between the pharmaceutical giant and the Australian Government over lengthy pricing negotiations for medicines recommended by the Pharmaceutical Benefits Advisory Committee (PBAC), with several discussions ultimately stalling over the price the government is prepared to pay versus the value Lilly seeks for innovative medicines under its global floor-pricing strategy.

That pricing pressure has taken on added significance as the US Administration’s most-favoured-nation (MFN) pricing policies increasingly influence global pricing decisions. Recent examples of stalled negotiations include Mounjaro (tirzepatide) for type 2 diabetes and obesity, Omvoh (mirikizumab) for ulcerative colitis, Kisunla (donanemab) for Alzheimer’s disease, and Ebglyss (lebrikizumab) for atopic dermatitis.

LillyDirect, powered by Evermed, allows patients to submit an electronic prescription (e-script) from their doctor through a secure online platform. The prescription is then directed to a licensed third-party pharmacist, who dispenses the medicine and arranges delivery directly to the patient’s home.

The platform is initially focused on selected Lilly medicines that are not funded through the PBS, including treatments for obesity, type 2 diabetes and moderate to severe obstructive sleep apnoea, with plans to expand to other Lilly medicines. The company said the platform will offer “competitive pricing” while removing some of the friction patients face in accessing treatments privately. It operates within established medicine supply frameworks and only after a medicine has been independently prescribed by a doctor.

Lilly Australia General Manager, Manny Simons, said the initiative reflects the increasingly difficult path from regulatory approval and PBAC recommendation to government-funded access.

“LillyDirect is about making medicines not funded through the PBS more accessible and affordable for more Australians,” he said.

Recent research shows almost half (43%) of Australian adults have been prescribed medicines not listed on the PBS in the past 12 months. For Lilly, that gap between medicines being available and medicines being government-funded is becoming an increasingly important battleground.

“Doctors and patients have told us they want more affordable access to our medicines. LillyDirect is one practical step we are taking to improve access and affordability of medicines for Australians, while we continue to advocate for broad reimbursement via other pathways,” added Simons. “LillyDirect will provide patients with improved access to medicines they need in a way that best suits them.”

The company, however, has not abandoned the PBS. Lilly affirmed it “remains committed to securing the PBS listing of new medicines, where it is viable to do so”.

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