Minister for Health and Aged Care, doorstop - 3 March 2024

Read the transcript of Minister Butler's doorstop on cheaper medicines; new medicines added to 60-day prescriptions; listing of Forxiga; heart failure; diabetes; ketamine.

The Hon Mark Butler MP
Minister for Health and Aged Care

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MINISTER FOR HEALTH AND AGED CARE, MARK BUTLER: Thanks everyone for coming out this morning to the fabulous Queen Elizabeth Hospital here in the western suburbs of Adelaide for another announcement about the Government's commitment to cheaper medicines. We went to the last election promising to make medicines cheaper for Australians and we've delivered a range of measures already to do just that. In 2022, we reduce the maximum amount that millions of pensioners and concession card holders would pay for their medicines across a given year by 25 per cent. A huge saving to about 2 million Australian pensioners such that their maximum cost for all of their medicines needs no matter how many scripts they're on over the course of the year is no more than an average of about $5 a week. Then on the 1st of January last year, we delivered the biggest cut to the price of medicines in the 75-year history of the PBS, more than a third of the price of a general patient script. And already just over the course of 2023 that delivered around a quarter of a billion dollars in savings to general patients. We also have made a very significant reform finally accepting the advice of the Pharmaceutical Benefits Advisory Committee, this is our medicine experts that guide our fabulous PBS or pharmaceutical benefits scheme. Their advice was to enable patients who are on common medicines for chronic or ongoing disease to be able to obtain 60-days supply of their medicines for the cost of a single script. And on the 1st of September last year, the first tranche of those common medicines became available at 60-days supply if a patient's doctor said that that was appropriate for that patient and since then, around 3 million 60-days scripts have been issued for the cost of a traditional 30-days script.
Today, I'm delighted to announce that on Friday, the 1st of March, another 94 medicines were added to that list. Those 94 medicines will now be available for 60-day supply if a doctor is willing to prescribe on that basis, and those medicines that are now on the list cover a range of very common widespread conditions in the community, type two diabetes is probably the most significant of them. Forxiga, which is a drug that we'll be talking about a little bit more later, a common medicine for type two diabetes. Metformin, another very common medicine that more than a million Australian patients use and many others besides will now be available on 60-day supply, but also medicines for breast cancer survivors, endometriosis, menopause, and a range of other common conditions impacting hundreds of thousands of Australian patients will now be available at 60-day supply. These are patients who are not only on the same medicine for months, but maybe for years or decades, or even the remainder of their life. It just doesn't make sense to require those patients to have to go back to a GP so regularly, to have to go to a pharmacy every single month, when they're on the same medicine at the same dose month after month, year after year. Sometimes, as I said decade after decade. This will save people time, it will save people money, it will free up desperately needed GP consultations for other more pressing health conditions rather than requiring people to go back simply for a repeat script.
I'm also delighted that since the 30th of June 2022, shortly after we were elected we've made 171 new or amended listings to the PBS. This is giving Australian patients affordable access to cutting edge treatments to help them with their health conditions. Today, I'm delighted to announce that for Forxiga which is as I've said, a pretty commonly prescribed medicine for type two diabetes right now and has been for some time, a drug from AstraZeneca, will also now be available on the PBS for chronic heart failure. Dr Chan will talk a little bit about this but around 180 patients are hospitalised every single day at hospitals like this the Queen Elizabeth and hospitals right across the country. Many of them are repeat hospitalisations for chronic heart failure. Forxiga is one medicine among a number of different options that can stop the progressive weakening of the heart, so the worsening of chronic heart failure, and alleviate a range of symptoms. We assessed that around 98,000 patients will be able to avail themselves now of a PBS listed version of Forxiga, 98,000 Australians who would otherwise be paying as much as $660 every year for this life changing treatment.
We're delighted to be able to make these announcements. Particularly delighted at the same time that we're adding so many common medicines to the 60-day list which will allow Australians to continue to enjoy the benefits of one of the great medicine schemes in the world, the PBS that provides Australian patients with access to life saving life changing, cutting edge treatments at affordable prices. Now I'm going to hand over to a couple of other speakers. First, Ben from AstraZeneca.
BEN MCDONALD, ASTRAZENECA PRESIDENT AUSTRALIA AND NEW ZEALAND: Thank you, Minister Butler. I'm Ben McDonald, the country president of AstraZeneca in Australia and in New Zealand. This is wonderful news for Australian patients. The PBS listing of Forxiga for chronic heart failure with preserved ejection fraction. AstraZeneca has been operating in Australia for over 60 years delivering innovative medicines, life changing medicines. We have over 100 medicines medicine indications listed on the PBS for Australian patients. This medicine ensures that patients will be able to benefit from what Forxiga offers, patients with chronic heart failure with preserved ejection fraction. Thousands of patients may be able to benefit from what Forxiga offers. AstraZeneca is very proud of this PBS listing and we will continue to invest in innovations and medical research for Australian patients. Thank you, Dr Chan.
DR ALICIA CHAN, CARDIOLOGIST: I'm Dr Alicia Chan. I'm a heart failure cardiologist working at the Royal Adelaide Hospital and the Queen Elizabeth Hospital. I am the current leader of the heart failure program in the Queen Elizabeth Hospital. So today, I will give you a quick rundown on what is heart failure and the impact on the patient and the importance of medications such as Forxiga being listed on the PBS. To start off with you may think I'm biased, but I think that the heart is the most important organ in our body. That is because the heart system is very much a pump system. For a pump system to work, it needs to be able to relax and receive all this oxygenated blood from the lungs, and then be able to squeeze it out to the rest of the body. When we talk about heart failure, we're talking about pump failure. There are two types of failure that can occur. The heart failure that we commonly know, it's because the heart is not able to squeeze and the muscles are damaged primarily for processes like heart attacks, drugs and alcohol is very common in our western population. What we're seeing more is from viruses, including the COVID virus can damage the muscle of the heart. Now there is a less commonly recognised type of heart failure, which is the preserved ejection fraction and that is due to a stiff heart. The heart is not able to relax, to fill up with enough healthy oxygenated blood. This is where that we really struggle with the treatment. We know that is associated with the ageing population, and the epidemic of obesity and diabetes that we're facing. It accounts currently for over half of the time of heart failure. The impact on the patient, however, it doesn't matter what type of heart failure, patients all end up with fluid build up. The symptoms from fluid build up will include shortness of breath, swelling in their bellies, swelling in their legs, and this can have significant impact on your lifestyle. One of the scariest things for me to see is when the patients come in with fluid overloaded in their lungs. They're so short of breath, that patients describe themselves as being drowning in their own fluids. That is an awful sensation.
There are some serious heart facts about heart failure that people are not aware of. Firstly, as mentioned by Mark earlier on, heart failure is currently the leading cause of hospital admissions, which is a significant burden on our health system. It's not heart attacks. People think heart attacks lead them to hospital admissions but heart failure currently accounts for the main reason for admission into the hospital. We also know that after one hospital admission, one in four patients will come back within 30 days. Heart failure is also a very deadly condition. It is lifelong and people are affected for a very long time. In a single year, heart failure kills more patients than cancer does But no one knows that. Everyone thinks that we are dying of cancer and heart attacks, but actually we're dying from heart failure. We also know that only half of our heart failure cohort are alive in five years. So very significant. Now, that's the bad side of heart failure. The good news is that we have worked very, very hard since the 80s, in focusing on the treatment of heart failure, and we have been very successful with the pump failure chart, the squeezing time to reduce ejection fraction. And we now have the four pillars of heart failure, some of which will include Forxiga, we have special pacemakers, defibrillators, and more advanced heart failure therapies that Graeme has, unfortunately had to go through and he'll share that with you.
The big black hole of heart failure treatment has always been with preserved ejection fraction, we have had no successful therapy for preserved ejection fraction just because it's a very complicated type of heart failure, up until 12 to 18 months ago, with the trials from Forxiga showing very good success rates, improving the symptoms of the patient, reducing hospital admissions, and also death. We are very excited as heart failure specialists and see Forxiga as a game changer in the management of heart failure, preserved ejection fraction. Before I hand over to Graeme, one last thing to say is that if you think you have any signs and symptoms that may indicate the onset of heart failure, please seek medical attention early, because we now have successful treatments, which are all subsidised by the government, and is accessible to you. It will make you live better and longer. Thank you.
JOURNALIST: Doctor, quickly before we move onto Graeme, you kind of touched on it a little bit there but what will this mean for patients with this particular preserved ejection fracture? How many more medications are available, are we talking a handful dozens?
DR CHAN: With the preserved ejection fraction, what we've been doing in the last 30 years is just giving them fluid tablets to offload them. The SGLT two inhibitors are the only class of medication to potentially change the cause of heart failure. There are no other medications for heart failure preserved ejection fraction, quite different to reduce ejection fraction. So, we are so excited about it.
GRAEME KLEMM, HEART FAILURE SURVIVOR AND TRANSPLANT RECIPIENT: My name is Graeme Klemm. Minister, as a heart failure survivor and transplant recipient, I can guarantee that the PBS assisting me to pay for my anti-rejection drugs, and Nicole who's a survivor as well, is saving us hundreds of dollars a month for the medications that we need to take for the rest of our lives. I guarantee that the 60-day dispensing will also assist those patients that are undergoing significant heart failure. Because when I was going through mine, I was finding it difficult to even walk 10 meters. So, to go out of the house to the pharmacy to be able to purchase medications was an extremely challenging thing to do. To be able to get extended prescriptions for a longer period of time will allow people like me to be able to work from home, and to live at home with the knowledge that I've got medicines on hand for, you know, for my condition.
I caught a virus in 2010. It led to me feeling challenged going upstairs within a few weeks. Within a few months, I found myself really challenged to lie down at night and go to sleep. So, when I was horizontal, like Alicia said I was waking up many times a night feeling as though I was drowning. It got to the point where I was having to sit in a recliner, to even get sleep at night time. I was finding myself falling asleep at work sitting at a desk because I wasn't moving. It got to the point where I needed to go to an emergency department and booked myself in for a diagnosis which was pneumonia at the time. Soon after I met a cardiologist that became my cardiologist for the next number of years. The first time I've engaged the cardiologist in my life. I hadn't been in the health system very much at all. And he was able to tell me that I was suffering from dilated cardiomyopathy which is one of the conditions that describes heart failure. He described my heart as being floppy. So, it wasn't a good thing to hear. But I was still pretty ignorant of what my body was going through. For the next six years, six and a half years, my life slowed down, my wife and children had to pick up the slack and home, my co-workers had to pick up the slack because I wasn't getting the output that I would normally do. As a lot of the heart failure, patients find they become anxious, depressed, feeling as though they're helpless, because they can't control what's going on, apart from being compliant with their medical team and taking tablets. I found myself going to tests, going to clinic, taking lots of pills, nothing seemed to be getting any better.
In 2017, I had to go into hospital number of times to get flushed out with an IV drip of frusemide, which is a diuretic, to try and get rid of the fluid that I had taken on board. Do you imagine having a dozen two litre bottles of water strapped to your body and walking around doing your daily routine, week after week after week, that's the burden that I was carrying so much fluid. I didn't realize at the time, I was still pretty ignorant of the process that was happening around me that my kidneys were shutting down. Therefore, I wasn't expressing the fluid out of my body, which meant I was going into organ failure, heart and kidney. It put me in a pretty dire situation. The third time I was in St. Andrew's hospital getting flushed, a visiting cardiologists came to see me, my normal cardiologist was away. He said to me, you're a bit of a pickle and the situation you're in means that you're probably going to die in a reasonably short period of time, because there's no solution for you. Has anybody talked to you about having a transplant? So with that discussion, it was a discussion that changed my life and saved it at the same time. He was able to get me to the Royal Adelaide for a public to public hospital transfer to the Alfred. My wife and I went on a medivac flight to Melbourne thinking we're going for a week of tests and discussions and try and get on the heart transplant list if I qualified. I want into complete organ failure when I got there, I was taken to a small cubicle off the cardiac ward. I was cannulated in both femoral arteries with some large cannulas and put on an ECMO machine which is a bypass machine. I woke up a week and a half later with a mechanical heart pump inside me. It’s a bit emotional reliving the memory. I spent 14 weeks in the Alfred, learning the technology, being able to understand how it works, getting it stable. Then another 13 weeks learning to walk again, because I had nerve damage from the ECMO process. Thirteen weeks later, I was able to come back to Adelaide, so six and a half months from getting there. We drove, my wife had flown back to get the car so we could bring all the equipment that I needed, battery packs, extra batteries, a whole lot of dressings and whatever. Not sure if you know what a mechanical heart pump is, but it's a pump that is attached to your heart sewn into your heart muscle while it's still beating. The pump is only about that big. It's quite small. It has a cannula going to one chamber of your heart and a drive line that comes out through your abdomen. They literally punch a hole through your muscle in your abdomen and you have a hole that has a drive line coming out attached to a battery pack and a control unit. That is the thing that sustains your life, your heart is pretty much dead.
I had to go through about seven weeks of dialysis to get all the fluid off to create some space. After they put the pump in there I was still overloaded and it was working well but I needed to shed that fluid. So even you know in that sense, it was really hard work even lying in a bit. We got back to Adelaide. We knew that Adelaide was a bit prone to blackouts at that point. so we were prepared, prepared our bedroom for that eventuality. Sure enough, there was a blackout one night so I was able to unplug from the bed and plug into the wall into power system at night time so it's a little bit easier to sleep. At 2:30 In the morning, this screeching alarm was going off. We were prepared for it and knew that it was a power failure. My wife had the torch. I have spare batteries plugged in. Good to go. That was our life for 13 months back here until I got the call to go back to the transplant. My rehab team from CAHLN was able to get me from not being able to walk when I got out of hospital, to running on a treadmill. That was my goal. To get the call to go back to the transplant was just awesome. I was out of hospital in 10 days, walk to the hotel, and haven't looked back.
The lifesaving journey that the Australian health system was able to provide me and so many other people about 100 or so each year to get a transplant, and quite a deal of people that are now getting mechanical heart pumps. And I note that the Minister was having a press conference a couple of weeks ago watching another mechanical device that is going to be better than an LVAD. On stream coming in the next five or 10 years, we're going to be having people that are zipped up and walking around with this technology inside them and nobody would know. That's the benefit of a good health system.
It's five years coming up in April for my transplant anniversary. For all intents and purposes, I'm living the life that I wanted to live. Because of the technology and the expertise of our health system. I can attest to the fact that Nicole had a different experience to me, so it'd be great if somebody who could speak to her about her experience. Hers was terrifying. I knew mine was happening and it was coming. But hers was simply terrifying. We have people in our community that are suffering this affliction. Now we've got better medicines, better technology, better expertise, the medications for anti-rejection are so far better than what they were 10 years ago. Our life prospects are so much greater.
One of the things that I did when I came back from my transplant was trying to get involved in the health system, maybe to give back and say thanks to the people that saved my life. I work at CALHN now as a consumer advocate. I go face to face with other heart failure patients, and talk to them about their experience and get feedback for our organisation. That allows us to get feedback and information to try and improve our services, improve our treatment, our care, and the services that we provide in both this hospital and the Royal Adelaide and other facilities around Adelaide. To be able to do that gives me great hope that other people will see what I'm doing and join the team. Nicole has just joined a team. So I’m really thrilled to have him on board. She's going to be sitting on committees to be able to get the feedback that my colleague and I get face to face with patients. She can feed that on to the organisation level, so that we can then continue to even further improve the treatment that we give people.
The stories that I hear from people coming in for the very first time, to the dire situation, a lot of people find themselves in the end in end stage heart failure. One of the great things that I've been able to, it's a privilege to be able to work with a cardiologist, my cardiologist at the Royal Adelaide to be able to go and visit people and talk to them about their journey. If they choose to go down this path. There are no guarantees that it’s going to work for them. Every single body is different. Everybody reacts to technology different. Not everybody comes out of the transplant operation. It's just a fact of life. It is a really hard operation to go through. What mechanical heart pumps do gives you time to get a bit fitter and healthier when you go in for the transplant. I was lucky in that regard. What I tell people when I go and see them and talk to them about these processes, either mechanical heart pump or transplant is the fact that this is their last chance. They need to make a decision is it forward or is it give up? If you're compliant and do everything that your medical team want you to do the chances are, it'll be successful. And many, many, many operations are. Afterwards, the journey is just beginning. The renewed sense of purpose that you get from coming out of that operation means that you can either get involved or just go back and live your life. I've chosen to become involved because I think it's important to model what we've been through to give people hope that they too can get to that point. Not everybody gets on the list, obviously. We don't have that many hearts that we can service everybody. It's a competitive situation, do a lot of factors. I was able to get involved in CALHN and I do that work, help my cardiologist help him assist people that are on that journey. I've been able to join the heart lung transplant trust in Victoria. To help people from each state get a bit of accommodation relief. I can guarantee that the financial impost on people going into state or even within Victoria or New South Wales where the two main transplant centres are in Australia. People going through heart failure have to spend a fair bit of money, people going through transplant and mechanical heart pumps, it is incredibly expensive going into state and living for any period of time. We had to rent an apartment on St Kilda Road near South Yarra and I had to be near the hospital because I couldn't walk, I was in a wheelchair, when I first got out, the damage that I sustained from the ECMO machine meant that I couldn't walk. So, you know, you can imagine the hundreds and hundreds and hundreds of dollars we had to spend per month living in Melbourne. I joined the trust to be able to help people raise money, so that it wouldn't be so expensive. We've gone from two beds to eight beds, we've decreased a little bit recently because of fundraising. And an apartment building that subsidizes we subsidize from a trust point of view, over half the amount of money that you need to be paying that hotel or apartment block to be able to live there for the period of time that you're in Melbourne, and it's open ended. So we were there three and a half months in an apartment, we fund half of that the government funds another portion of that journey. And out of pocket patients have to pay a very little amount, $10 a night. I got involved in that. I also write and publish a magazine called The Circulator which I've got some copies around. If you want to take that features stories about transplant and mechanical heart pump patients, as well as information so that they can read and become more educated about their journey. I was really lucky to partner with our two produces LVAD machines and other technology to have 500 copies of that magazine, distributed around Tasmania, Victoria and South Australia, cardiology and GP clinics to try and educate people that are in the heart failure space. I've joined the heart transplant pilot registry to try and help them understand from the consumers point of view, what information we would like to have coming out of that space. The CEIH, which is a state based Centre of Excellence in South Australia, I joined the cardiac state-wide care steering committee to be able to inform from a consumers perspective, things that you know, they are taking on board to try and assist cardiac patients around the state with rehab and also treatment. I can't think of a better way to give back and honour the gift that I've been given then to be able to work in that environment. Thanks very much.
BUTLER: Thanks, Graeme, for an incredible tribute to your resilience, but also the work and the support that you've got from clinicians here and over in Melbourne at the Alfred. Happy to take questions.
JOURNALIST: So how much exactly are they going to be saving on the PBS?
BUTLER: I'm advised without a listing on the PBS this will cost about $660 per year. So for a concessional script, which is pensioners, people on concession cards, they'll be paying just a little bit more than $7 a month, so about $140 instead, but they might be they might be qualifying for the safety net adjustment for the thresholds. That means they don't pay for any of their medicines. All of these medicines, they're cutting edge, but they are often quite expensive. That's why the PBS listing process is so important so that people can get affordable access to these cutting-edge treatments.
JOURNALIST: It seems like there are a lot of Australians are affected with this particular strain, or this particular type of heart failure. If there are others that don't have this, can they still use this medication, or is there going to be other options for them?
BUTLER: Well, I might ask Alicia about that. This is one of many, many medicines that are listed on the PBS for cardiac conditions including chronic heart failure. This, as Dr Chan has said, is a particular type of chronic heart failure that has been very stubborn, and for which there haven't been a sort of game changing treatment light Forxiga. This will be a very significant step forward for the many, many tens of thousands of patients who will be qualifying for it.
JOURNALIST: On the Dunkley by-election, the 3.7 per cent swing to the Liberals, are you concerned if that swing was replicated across the country at the next election that might mean that you won’t be able to form a majority government?
BUTLER: Of course by-elections have their own dynamic and are very different to a general election dynamic when the population is really choosing between two alternative Prime Ministers. We're obviously delighted that Jodie Belyae, who was a terrific candidate, and will be a terrific Member of Parliament was successful last night a great tribute to her departed friend, the late Peta Murphy, who was such a terrific member for that state. Of course, we'll analyse the result as any government should, we'll have a look at a whole range of elements of it, but we're really pleased that Jodie Belyea will be will be joining our team and fighting for the people of Frankston that part of southeast Melbourne and the peninsula.
JOURNLAIST: How would you describe last night's result?
BUTLER: We're delighted that Jodie Belyea was able to come through. It was a strong campaign, there were a lot of resources thrown at her including not just obviously from the opposition, but by Advance Australia as well. She just kept focused on the issues that are important to her community, particularly cost of living issues.
JOURNALIST: I just have some questions around type two diabetes, what do you say to clinicians calling for greater access to life changing technologies for those living with diabetes?
BUTLER: Constant glucose monitoring or CGM devices have been a life changer for many tens of thousands of patients with type one diabetes, including very small children who are now able to have their insulin levels remotely monitored by their parents while they're at school. Some of the technology now means that they can swim, they can participate in contact sport and really live a normal life playing and being active at school right through the course of their lives. We've made really significant investments to make that treatment and that support widely available and affordable for all Australians. I've seen though, of course, some calls for those technologies to be made available to patients with type two diabetes, obviously, a different form of diabetes. We have a House of Representatives Standing Committee on Health inquiry into diabetes that's going on right now, they are receiving a whole lot of evidence about the particular challenges for families and patients living with diabetes, whether it's type one or type two, and I know that this particular issue is being ventilated through the course of that inquiry. I want to see that inquiry run its course. It's chaired by Dr Mike Freelander a terrific Member of Parliament, but a doctor of decade standing and other doctors have been elected to the parliament on that committee as well. So, we're taking it very seriously. But I want to see that inquiry, run its course be able to report to me as the health minister the government more broadly, and then we'll start looking at those issues.
JOURNALIST: What do you say to those claiming people living with type two diabetes have been stigmatized because of beliefs, it's caused by lifestyle?
BUTLER: I think that is an issue that's also being raised through the course of this inquiry. You know, we have a very big increase in the number of Australians living with type two diabetes. Some of the clinicians here at the Queen Elizabeth and I were only talking about that before this press conference. There are a range of challenges for our community and for government to drive down the prevalence of type two diabetes in the community and to give more support to people who are living with it. That's why I was really delighted when Dr Freelander suggested to me that the next inquiry, the next parliamentary inquiry in the health area, which as you can imagine, has so many potential candidates for inquiry, that the next inquiry would be diabetes, and that's what they're looking at right now will cover a whole range of issues, including the stigma issues that you raised that are there in the community that are there, frankly, in some areas of the health sector itself, as well as access to cutting edge treatments.
JOURNALIST: Will the government act to help all Australians struggling with diabetes?
BUTLER: I don't have anything further to add about that, we treat these issues as serious enough to warrant a very substantial parliamentary inquiry into it. I'm really looking forward to that inquiry, finishing its work and providing a really ambitious report to government.
JOURNALIST: I just wanted to ask you from a health perspective, please about the dangers of recreational drug ketamine?
BUTLER: Last week, we received a landmark report from the Institute of Health and Welfare on the latest usage data, if you like of alcohol and other drugs. It's a very big report that we're working our way through but there were a number of quite alarming elements of that report, including a very big rise in the use of ketamine but many other alarming factors, as well, not only around illicit drugs, but also in some cohorts of the population around very risky or dangerous uses of alcohol. I met with the Advisory Council on our alcohol and other drugs, this is a group of experts set up by but former government to provide government with advice about alcohol and other drugs policy. We talked through only on Friday at some length that the data that we had seen through that Institute of Health and Welfare report, including the alarming rise in the incidence of ketamine use, and I've asked them to provide me as the health minister with some advice about the background trends that explain really what we see in that data. I'm looking forward to receiving that advice. I imagine talking to my colleagues as well, because a lot of the levers around these issues are really held by state governments. I'm sure my health minister colleagues will be looking forward to a good deep discussion about this latest report from the Institute of Health and Welfare. Thanks very much.

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