Who’s really to blame for the MS medicines pricing dispute?

A forty percent (40%) price cut imposed on Neuraxpharm as a condition of listing its multiple sclerosis (MS) medicine Briumvi (ublituximab) on the Pharmaceutical Benefits Scheme (PBS) is now being blamed for threatening future patient access to Roche’s Ocrevus (ocrelizumab) and Novartis’ Kesimpta (ofatumumab).

Briumvi was listed on the PBS on 1 January 2026. As part of the listing, the Department of Health’s Pricing and Policy Branch required Neuraxpharm to accept a PBS price around 40% lower than Ocrevus and Kesimpta. Critics argue the decision exposes a disparate pricing approach, given those medicines were listed since 2018 and 2021 respectively and despite comparable clinical and economic value.

The pricing outcome has fuelled criticism that the government used its negotiating leverage over a smaller pharmaceutical company that had only recently established operations in Australia. Faced with the choice of accepting the lower price or abandoning the Australian launch of Briumvi for patients with relapsing-remitting multiple sclerosis (RRMS), the company proceeded after investing around $500,000 in Therapeutic Goods Administration (TGA) and Pharmaceutical Benefits Advisory Committee (PBAC) submissions.

The potential withdrawal of Ocrevus, available in both intravenous (IV) and subcutaneous formulations, would be a significant blow 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.

Roche Australia General Manager, Dr Nic Horridge, confirmed that the Department of Health has stipulated “a substantial price cut for the most commonly used MS medicines, including Ocrevus, to remain on the PBS”.

“This cut, should it stand, would make it impossible to keep Ocrevus on the PBS and would lead to the Australian Government removing Ocrevus from the PBS,” Dr Horridge said. “Minister Butler and his department understand what is at stake. At their direction, the Pharmaceutical Benefits Advisory Committee will meet next week to provide advice on viable and sustainable pricing of the most commonly used MS medicines, including Ocrevus.”

The dispute has intensified concerns that the pharmaceutical pricing framework is becoming increasingly disconnected from real-world patient access.

MS Australia Acting CEO Dr Julia Morahan said “It is not MS Australia’s wish nor our place to be involved in industry negotiations regarding drug pricing. Our focus is however, in advocating strongly for continued access to life-changing, high-efficacy medications on the PBS.”

The concerns were echoed from the industry side, with Novartis also warning of potential impacts on patient care and system-wide flow-on effects.

“Changes that require patients to switch medicines for non-clinical reasons risk disrupting care and could result in a relapse or disease progression. This could be even more pronounced for people in regional and remote communities, where access to specialists and infusion services is already challenging,” Novartis told Health Industry Hub in a statement. “This situation highlights broader issues with the PBS, where pricing policies can be applied without thorough consideration of the impact to patient access and other parts of the healthcare system, including hospitals and the NDIS.”

The dispute has also prompted broader questions about the government’s negotiating strategy. With Roche and Novartis each supplying numerous medicines funded through the PBS, some industry observers argue there may be greater scope to negotiate savings across broader therapy portfolios while maintaining reimbursement levels for the MS medicines that also need to satisfy global pricing expectations.

Federal Health Minister Mark Butler has defended the PBS, saying “In Australia, we only fund new medicines when the evidence shows they genuinely work and offer good value for taxpayers.”

The timing is unlikely to be coincidental. As negotiations on the Strategic Agreement between the government and Medicines Australia commence today, the MS pricing dispute has become an early test of how aggressively the government intends to pursue savings as part of the broader reforms flowing from the Agreement.

Whether this dispute reflects prudent fiscal management or an increasingly uncompromising approach to pharmaceutical pricing may ultimately determine more than the future of MS medicines. It also raises a broader policy question: are PBS savings such as these intended to fund the Health Technology Assessment (HTA) Review reforms now folded into the Strategic Agreement negotiations?

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