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Australia still retains its place as being great for pharmaceutical, biotech and medical technology companies to do business in. Like other advanced economies, Australia is looking for innovative ways to provide quality and sustainable healthcare for its citizens.
In the last 10 months there have been several developments in the Australian policy scope that have the ability to dictate future government strategies and tactics.
Potential implications for the reimbursement of medical devices, prosthesis and pharmaceuticals was recently discussed by Sarah Griffin and George Papadopoulos of Partner Organisations Medtechnique Consulting and Emerald Corporate Group during a webinar presentation.
Medical Technology Reimbursement
Whilst Australia has a universal healthcare system (Medicare), nearly half of all Australians possess Private Health Insurance (PHI). However, PHI is for hospitals and provides limited ancillary cover, excluding costs of primary care and pharmaceuticals. Consequently this results in Australia having a mix of public and private hospital systems which is somewhat fragmented with lots of perverse incentives.
The Medical Benefits Schedule (MBS) is a list of medical procedures that are subsidised by Medicare. Furthermore, for a procedure to be covered by PHI, it must be included on the MBS. Implantable devices such as hips, pacemakers and vascular grafts receive a payment over and above any other reimbursement and are placed on the Prosthesis List. Unfortunately, devices that are not implanted are at a disadvantage as they do not have a pathway for public or private reimbursement.
There are currently seven health reviews being undertaken in Australia in 2016, two of which will impact the Medical Technology Space in Australia and are:
The Private Health Insurance Review is expected to be completed in late 2016.
The Medical Benefits Schedule Review is expected to be completed in late 2016.
The Pharmaceutical Benefits Scheme (PBS) is the list of subsidised pharmaceuticals and remains a key pillar of the National Health Framework of Australia.
The Pharmaceutical Benefits Advisor Committee (PBAC) Guidelines remain key for a drug to gain access onto the PBS. The current version of the guidelines (Version 4.5) is expected to be replaced by Version 5.0 (of which drafts are available) in November 2016 ready for implementation by March 2017.
Price disclosure has been a means for the government to minimise the budget impact of pharmaceuticals. 1 April 2016 saw the first of F1 5% price reductions but October 2016 plans to bring further price decreases to the cost of Efficient Funding of Chemotherapy (EFC) drugs and non-EFC drugs. These reductions have their repercussions and were discussed.
The public release of linkable 10% sample of Medicare Benefits Scheme (Medicare) & Pharmaceutical Benefits Scheme (PBS) data in August 2016 was touched on with its potential also mentioned. This release has seen approximately 1 billion lines of de-identified historical health data relating to approximately 3 million Australians, allowing for research institutions, healthcare professionals and universities to have access to linkable, individual Medicare and PBS claims data for a random 10% sample of Australians.
The Life Savings Drug Programme (LSDP) is an alternative supply arrangement outside of the PBS which currently has twelve medicines for the treatment of eight conditions. It is a specific programme conducted by the Australian Government to provide subsidised access for eligible patients to life saving drugs for rare life-threatening conditions. The review of this program was expected to have been released in early 2016 with results of which still pending.
Lastly, a review of Pharmacy Remuneration and Regulation is currently being conducted. A panel of three independent expert reviewers will undertake the review and provide recommendations on: future remuneration, regulations including Pharmacy Location Rules, and other arrangements that apply to pharmacy and wholesalers for the dispensing and supply of medicines and other services. A final report is expected to be provided to the Minister for Health by March 2017.