Senate hearing lays bare clashing narratives on HTA Review and PBS reform

More than two years after the Health Technology Assessment (HTA) Review was handed to government, Senate Estimates has exposed competing narratives, with consultation expanding while implementation remains opaque and difficult to pin down in any measurable way.

Shadow Minister for Health Senator Anne Ruston demanded a straight answer on progress, asking how many of the HTA Review’s recommendations have actually been implemented.

Department of Health Secretary Blair Comley conceded he could not provide a definitive figure, offering instead a formulation that effectively highlighted the lack of transparency and accountability.

“It’s not quite as straightforward to say something is fully implemented or not, because they are sometimes quite high level. Some people would take the view they have been fully implemented, others would say it hasn’t gone as far as I’d like. it’s not clear cut,” he said.

Senator Ruston used the ambiguity to sharpen her attack, pointing to what she described as mounting “community anxiety” across stakeholders who believe the review has been “kicked into the long grass”.

She called for a full line by line progress report across every recommendation, including completed measures, planned actions and those that have not even received a formal response. She also pressed for a public commitment to release the implementation roadmap for the HTA Review, which has been sitting with Federal Health Minister Mark Butler since December 2025.

Senator Nita Green defended the government’s position, telling the committee, “We are working with the Implementation Advisory Group (IAG) on the recommendations of the HTA review and that work is being considered by the Minister.”

The exchange escalated further when Senator Ruston questioned whether any concrete measures flowing from the HTA Review had been funded in the 2026-27 Federal Budget. Rather than directly answering, Deputy Secretary for Health Resourcing at the Department of Health Penny Shakespeare pointed to recent Pharmaceutical Benefits Scheme (PBS) listings, including Bristol Myers Squibb’s (BMS) tumour agnostic listing.

Senator Ruston dismissed the answer as deflection, pressing officials to confront what she framed as a structural blockage, asking whether the delay was driven by “cost, capacity, or political will”.

Despite repeated assurances that work is underway, officials were unable to identify any dedicated funding stream or provide any credible timeline for delivery. Comley and Shakespeare referenced feedback from medicines companies but did not address the broader dissatisfaction from patient advocacy organisations and clinicians, who have been increasingly vocal about the absence of visible change.

Attention then shifted to rising international pressure on Australia’s HTA framework, particularly the potential disruption from the US Government’s Most Favoured Nation (MFN) pricing policy.

First Assistant Secretary, Technology Assessment and Access at the Department of Health, Duncan McIntyre, said “We’re monitoring the risk in the geostrategic environment, and we are developing responses to be able to deal with anything, should it be necessary.”

Senator Ruston then turned to Eli Lilly’s decision not to proceed with listing Mounjaro on the PBS, a move the company has linked to international pricing pressure. She asked whether this had forced government to accelerate its response to emerging MFN risks.

“There is an existing GLP1-RA medicine listed on the PBS for type two diabetes, so in this case we don’t necessarily have a significant impact on patients,” Shakespeare explained referring to Novo Nordisk’s Ozempic (semaglutide).

The exchange sharpened again when Senator Ruston referenced comments from Medicines Australia’s CEO Liz de Somer, who recently labelled the PBS as “broken” following Lilly’s withdrawal from pursuing a listing for Mounjaro.

Duncan McIntyre mounted a strong defence of the PBS, citing the HTA Review and international benchmarking as evidence of strength rather than failure.

“The HTA review found that the PBS represented one of the most functional systems in the world. We are often found to be amongst the top countries in terms of assessing the value of medicines and paying on the basis of the value for those medicines,” he said.

That defence sits in stark contrast with OECD data showing Australia funds only 26% of new medicines available in comparable countries. The ‘failure to list’ is now driving a parallel crisis of affordability, with nearly one in two Australians facing out-of-pocket costs and 43% of Australians prescribed medicines not listed on the PBS.

Senator Ruston accused the government of failing to convert consultation into delivery, arguing the system is losing credibility as reform timelines stretch without explanation or accountability.

With the HTA Review funding blackout exposed and its deferral into the next Strategic Agreement between Medicines Australia and the government, the pharmaceutical sector is bracing for another politically charged round of negotiations.

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