Specialists call for faster reimbursement and greater clinician input on new medicines

Pharma News: Innovative medicines in Australia are facing significant obstacles when it comes to accessibility and reimbursement, according to research commissioned by Eli Lilly Australia. The research sheds light on the opinions of medical specialists regarding the current state of medicine access, use and supply in the country.

A staggering 98% of clinicians surveyed believe that Australia should rank higher than its current position of 16th among OECD countries in terms of reimbursed new molecular entities. In fact, 65% of the specialists expressed a strong desire for Australia to be within the top 5 nations for reimbursed medicines access. These findings highlight a pressing need for faster, more efficient processes in medicine funding.

Tori Brown, General Manager of Eli Lilly Australia and New Zealand, emphasised the relevance of the research in light of the ongoing review of Health Technology Assessment (HTA) processes.

“It is important that policy discussions are informed by the views of medical specialists – the very people responsible for the care of patients with chronic and complex health issues, and the primary prescribers of innovative medicines,” said Ms Brown.

The research found that over 70% of specialists believe there should be greater clinician input in the decision-making process for which medicines are listed on the Pharmaceutical Benefits Scheme (PBS) and for which patients. Recognising the value of bolstering the clinician voice on medicines access, Lilly supports prioritising patient needs and rewarding pharmaceutical innovation.

Improved access to medicines was identified as a critical factor in enhancing health outcomes for Australian patients, with a majority of clinicians expressing support for broader access to medicines both from overseas and within the PBS. Specifically, 56% of clinicians agreed that making medicines routinely used overseas available through the PBS could lead to significant improvements in health outcomes. Additionally, 70% of clinicians advocated for relaxing eligibility criteria for medicines already listed on the PBS.

One glaring issue highlighted in the research was the timeliness of medicine reimbursement in Australia. Clinicians unanimously criticised the current average timeframe of 466 days between Therapeutic Goods Administration (TGA) registration and PBS reimbursement. The overwhelming majority of specialists found this duration unacceptable, with 37% indicating that a timeframe of up to 100 days and 44% finding 101-200 days acceptable. The research also revealed strong support (87% agreement) for a fast-track PBS-funding process for medicines addressing highly unmet medical needs, as well as breakthrough medicines (77% agreement).

Dr Gabrielle Reppen, Senior Director of Corporate Affairs and Market Access at Eli Lilly Australia, emphasised the urgency of the clinicians’ message. She stated “Australians deserve more timely and equitable access to innovative medicines. These research findings will form part of Lilly’s submission to the government’s Health Technology Assessment Review in support of bold policy change to ensure the PBS is fit-for-purpose and sustainable in the long-term.”

The study also addressed concerns regarding government expenditure on pharmaceuticals, with 85% of clinicians worried that reductions in spending on the PBS may have adverse effects on patient outcomes. Furthermore, 70% of clinicians believe that any cost-savings resulting from PBS reform should be reinvested back into the PBS.

Notably, the research uncovered that a significant majority (78%) of clinicians believe it is the government’s responsibility to ensure that price negotiations with pharmaceutical companies do not disrupt the supply of PBS-listed medicines for patients in need. The research highlighted concerns regarding the comparatively low dollar value assigned to life and health outcomes in Australia’s HTA processes, potentially denying or delaying patient access to crucial medicines, vaccines, and other health technologies.

Interestingly, only 37% of clinicians reported discussing both PBS-listed and private prescription treatment options with most patients. Clinicians tended to be more cautious when discussing non-reimbursed options. This suggests a need for improved communication and transparency regarding treatment options.

Clinicians participating in the study offered valuable insights, with some suggesting mechanisms for faster approval of medications on the PBS based on robust safety and efficacy data. Others recommended time-limited fast-track approvals as an interim measure to expedite access while regular processes take their course. Concerns were raised about delays in PBS listing, especially for effective and reliable medications used in end-of-life care, creating a two-tier system that disadvantages patients who cannot afford them.

The research findings carry significant implications for the Australian healthcare landscape. With the voices of medical specialists at the forefront, there is a growing demand for policy changes that prioritise patient needs, expedite access to innovative medicines, and ensure a sustainable and equitable healthcare system.

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