The PBS deal that put MS care on a collision course

Federal Health Minister Mark Butler is facing mounting pressure to “guarantee” that two multiple sclerosis (MS) treatments at the centre of a bitter pricing dispute will remain available through the Pharmaceutical Benefits Scheme (PBS), as concerns grow that government cost-cutting measures is triggering unintended consequences for patients.

The Pharmaceutical Benefits Advisory Committee (PBAC) met with stakeholders this week to consider the fate of the two disease-modifying therapies (DMTs), Roche’s Ocrevus (ocrelizumab) and Novartis’ Kesimpta (ofatumumab).

The pricing dispute has escalated following the Department of Health’s decision to impose a forty percent (40%) price reduction on Neuraxpharm as a condition of listing its MS therapy Briumvi (ublituximab) on the PBS in January 2026. That decision is now being blamed for creating a chain reaction that threatens ongoing access to Ocrevus and Kesimpta.

The controversy raises a fundamental question: why would Neuraxpharm opt for a substantial price cut when its treatment offers comparable clinical and economic value to existing competitors? The government used its negotiating leverage over a smaller pharmaceutical company that had only recently established operations in Australia, exerting pressure that resulted in a significant undervaluation of its medicine.

Questions have also emerged over whether the therapies involved can be considered clinically interchangeable in real-world practice.

While not a prospective study, a case report series examining real-world data from patients switched from Ocrevus and Kesimpta to Briumvi concluded that “within-class switching from a prior anti-CD20 mAb therapy to ublituximab is feasible and may improve outcomes in some people with MS”.

Despite this, the potential withdrawal of Ocrevus, available in both intravenous (IV) and subcutaneous formulations, would be a significant setback for patients. While Briumvi, also administered intravenously, could provide an alternative switch option for some of these patients, the possible withdrawal of Kesimpta from the market would remove the only subcutaneous treatment option, a scenario that warrants even greater consideration by the PBAC.

“I want to see these drugs kept on the PBS. They’re delivering enormous benefit to patients. But I want to see the outcome of that [PBAC] work over the course of this week,” said Minister Butler.

The dispute has already prompted Biogen to agree to a price reduction for Tysabri (natalizumab), with the decision potentially resulting in workforce restructuring and redundancies.

Associate Professor Geoffrey Herkes, the designated neurology expert representing the field on the PBAC, will be central to the Committee’s deliberations as it weighs the competing demands of affordability, sustainability and patient access. The PBAC’s decision, expected within the next two weeks, will determine whether this PBS deal becomes another case arising from the unintended consequences of aggressive cost-cutting.

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