Minister for Health and Aged Care – doorstop in Canberra – 9 August 2023

Read the transcript of Minister Butler's doorstop in Canberra about cheaper medicines and Medicare-subsidised psychology sessions.

The Hon Mark Butler MP
Minister for Health and Aged Care

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MINISTER FOR HEALTH AND AGED CARE, MARK BUTLER: More than three months ago now I announced the latest wave in our Government's commitment to deliver cheaper medicines. That would be through accepting advice from the Pharmaceutical Benefits Advisory Committee to allow doctors to issue 60-day prescriptions for common ongoing health conditions. More than 300 medicines that people are often on not just for years, or even decades, they're often on for the entire rest of their lives. 30-day scripts make a lot of sense for the old patient profile, which used to be a single bout of infectious disease, a single episode of care, that required a single course of medicine. That's not what patients tend to experience today, they are often on these medicines for many, many years. That's why so many countries to which we usually compare ourselves allow 60 or even 90-day prescriptions. This was advice given to the former government around five years ago. But after a discussion with the pharmacy lobby, the former government decided not to proceed with that. And as a result, patients with ongoing health conditions have paid literally hundreds and hundreds of millions of dollars in fees that they shouldn't have had to pay, if the advice of medicine experts had been accepted. Now, this is good for the hip pocket, obviously, it halves the cost of these medicines for patients, but it's also good for health. And it frees up millions of GP consults that we desperately need for important health conditions, rather than just routine scripts being issued by doctors. All of those reasons are why this has been supported by every significant patient group in the country and every doctors’ group as well.
Now, a little while ago, a motion in the Senate was tabled to block this measure - to block access for six million Australians to cheaper medicines. A Disallowance Motion that was lodged by Senator Ruston and Senator McKenzie on behalf of the Coalition, the One Nation Senators and also the new independent Senator, Senator David Van. This Disallowance Motion needs to be dealt with quickly, because the Parliament rises tomorrow, and access to cheaper medicines, if it is not disallowed by the Senate, will start to take effect before the Parliament resumes.
The Senate now has a choice over the next 24 hours: either allow access to cheaper medicines for six million Australians, as recommended by the medicines experts, as supported by every patient and doctor group, or really accept the position of the Coalition and the pharmacy lobby, that cheaper medicines should not be proceeded with in this country. They took that position five years ago. They take that position now. It can be expected that they'll continue to take that position in the future.

I need to be clear about what the consequences of disallowing this measure will be. Because not only will it block access to cheaper medicines for six million Australians, but $1.2 billion worth of investment in community pharmacy for the benefit of customers will also need to be withdrawn, because they are funded by this saving.
Those include this: the former government and the Pharmacy Guild signed an agreement -the 7th Community Pharmacy agreement - that did not contain sufficient funds to continue pharmacy programs for the entire five years of the agreement. So common pharmacy programs like dose administration aids - the Webster packs that pharmacies often provide for particularly elderly patients – was unfunded beyond 30th of June and will be unfunded if the Senate chooses to support Senator Ruston’s motion. We also said we’d expand the ability of pharmacists to provide vaccinations under the National Immunisation Program, that measure will not go ahead. We also doubled the Regional Pharmacy Maintenance Allowance, the allowance that rural pharmacies get to operate in rural communities. That measure will have to be withdrawn. It took effect on the 1st of July. And also the opioid dependence treatment program, which gave PBS access to the 50,000 or so people on opioid dependence treatment - so methadone or buprenorphine injections - was also funded by this savings. So that would be called into question as well.
Finally, I announced a little while ago that we had decided to bring forward negotiations early for the next Community Pharmacy Agreement, the 8th Community Pharmacy Agreement, in response to a request to do so from the pharmacy lobby, the Pharmacy Guild. Obviously, that request was tied to the 60-day prescription measure. If the Senate blocks that measure tomorrow, then obviously, there is no need to bring forward negotiations for the 8th Community Pharmacy Agreement. We'll let the existing Agreement run its course and reserve our rights in relation to future arrangements. Happy to take questions.
JOURNALIST: The Coalition say that they want a pause, not to tear it up. Why didn't you decide to go with that option?
BUTLER: This option was not put to us. Let's be really clear about the Coalition's position on this: they've lodged a motion in the Senate that is very clear in its terms: to disallow this measure. There are 24 hours left, effectively, of Parliamentary time until this measure takes effect. So, we need to deal with this tomorrow.
JOURNALIST: So, no pause?
BUTLER: There is no proposal in the Senate to pause this measure. This measure was announced three months ago, I first told the Pharmacy Guild about it several weeks before that. We've been talking with the pharmacy sector about the best way in which to reinvest every single dollar that we save as a Commonwealth, and I announced just the last tranche of that reinvestment last week, after particularly listening to rural pharmacies and crossbenchers and others who've been advocating the position of rural pharmacies.
The Coalition and the Guild opposed this measure five years ago. They oppose it today. Does anyone seriously expect that they're not going to oppose it in six months? This measure has been hanging around on the books for five years, and because of the Coalition's opposition for five years, 6 million patients have gone without cheaper medicines. Because the Coalition back the pharmacy lobby, instead of six million patients, those patients have shelled out hundreds and hundreds of millions of dollars, that the medicines experts who manage the PBS have said they shouldn't have had to pay. That is the choice before the Senate tomorrow, as well as the continuation of all of those measures I went through, that would be funded by the savings that the Commonwealth makes through this measure.
JOURNALIST: The Greens have already said that they won’t support the Coalition. Do you know what the other crossbenchers are thinking? Have you locked in anyone either way?
BUTLER: This Disallowance was only tabled in the last hour or so - at least only announced in the last hour or so. We've had terrific discussions with all crossbenchers in both houses. Obviously, the Senate actually gets a vote on this. But we've been talking to crossbenchers in both Houses about this measure. We’ll obviously continue those discussions overnight, before this measure is dealt with by the Senate tomorrow. But I do stress that those reinvestment measures that I went through were crafted very carefully after discussions with people in the pharmacy sector, but also with crossbenchers who come from a range of different diverse areas in Australia, all representing quite different communities. And we listened very carefully to what they had to say about the best way in which to reinvest that $1.2 billion.
JOURNALIST: How confident are you that your next conversation with the Guild will be productive and in good faith given that there's been quite an escalation in public dispute between you and them in the last few weeks?
BUTLER: I wouldn't characterise it as that. We are determined to deliver this measure to deliver cheaper medicines for 6 million Australians. It's well past time. This recommendation has been on the books for five years. Now, I've listened to the representations from the Pharmacy Guild, as has the Prime Minister, other members of the ERC and the Cabinet and decided to bring forward negotiations for the next Agreement. But obviously, that decision was tied to the cheaper medicines measure passing - that was the reason for the request being made in the first place. If the Senate decides to block access to cheaper medicines, as I said, there's obviously no need to bring forward negotiations for the 8th Community Pharmacy Agreement. That would continue to run its course until mid-2025 and we reserve our rights in relation to future arrangement.
JOURNALIST: What would be the natural consequences if that were to lapse without a new Agreement being formed?
BUTLER: Then pharmacy remuneration reverts to a different arrangement. That hasn't been the case for the last I think 35 years or so, where pharmacy remuneration or pharmacy business remuneration has been determined by an Agreement struck between the industry and the government of the day. But obviously, that would be a matter for the future, what the arrangements would be after 2025. Obviously, our preferred position, our strongly preferred position, is that the Senate supports the interests of six million patients and delivers this cheaper medicines measure that, frankly, should have been delivered four or five years ago, and that we're allowed to continue the sensible reinvestments that will start to expand the work that pharmacists are able to do in areas like immunisation, that will give access to PBS prices to the 50,000 or so Australians living with opioid dependence. And also bring forward negotiations for a new Agreement that will take account of all of those changes that are happening in pharmacy.
JOURNALIST: Minister, it's been some seven or eight months since the Medicare-subsidised mental health sessions went from 20 back to 10. At the time, you said the reason that it was cut back to the original 10 was because the 20 actually put pressure on the system, people were missing out and the lines were longer. Are the lines to see a mental health professional now shorter? Is it easier for people to see a mental health professional in the bush, has that pressure been taken off the system?
BUTLER: A couple of points about that. Firstly, the reason why the number of available sessions went from 20 to 10 is the product of a decision made by the former government: it was always a time-limited measure that was tied to the COVID lockdowns. And the decision around that measure stopping on the 31st of December was effectively a decision of the last Budget of the former government that was delivered before the election last year. Now, I said that we were determined not to change that standing position we inherited from the former government, in part because of the terms of the evaluation I received, in part because of what that said about the fact that those measures, as many predicted, frankly, actually lead to worse access, not better access, which is the name of the program. Significantly fewer people got access to psychology sessions at all. I'm very pleased to say - I don't have the number in my head - but I'm very pleased to say that although the measure that the former government introduced led to some tens of thousands of fewer new entrants to the scheme, so fewer people got into the scheme in the first place, this year - over the first six months of this year - tens of thousands more people got access. So many more people now have access to psychology sessions than was the case before. I don't have the number in my head, but it is in tens of thousands.
JOURNALIST: You’ve brought forward negotiations for the next CPA. But will you bring forward the start date?
BUTLER: That obviously depends on the negotiations. We're not particularly keen on negotiating for two years, I can assure you of that. Currently, the next Agreement is due to start on the 1st of July 2025. Bringing forward those negotiations, obviously, indicates that we would like to see a negotiation successfully conclude a new Agreement, which would almost certainly see that new Agreement start early. But we're not going to lock ourselves into a rigid, short timeframe. That's not a good position in which to negotiate with taxpayers’ money. We will negotiate – if 8CPA negotiations do continue to be brought forward, which depends on the Senate’s position tomorrow - we'll negotiate in good faith, but we'll negotiate with the best interests of patients and a viable community pharmacy sector in mind.
JOURNALIST: The Guild says it wants to up to $3.3 billion restored to the community pharmacy sector, would you entertain the idea of pouring more government money into pharmacies?
BUTLER: I don't have anything to add to what I said. We'll go into negotiations in good faith. If we think those negotiations are going to proceed early, but as I said that depends really on the position of the Senate tomorrow. Thanks, everyone.

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