Minister for Health and Aged Care – podcast interview on Australian Politics (The Guardian) – 12 August 2023

Read the transcript of Mark Butler's interview with Paul Karp on The Guardian's Australian Politics podcast about cheaper medicines, Ozempic, vaping and Urgent Care Clinics.

The Hon Mark Butler MP
Minister for Health and Aged Care

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PAUL KARP, HOST: For listeners who might not be familiar with the policy, let's go back to the start. What is 60-day dispensing? How does it save patients money? And does that save then come out of the pockets of community pharmacy?


MINISTER FOR HEALTH AND AGED CARE, MARK BUTLER: A lot of questions there. Let's go back to the baseline position. Australia generally has 30-day prescription. So you go to a doctor, the doctor will prescribe a medicine for whatever your condition is and go and get 30-days’ supply of medicine from your pharmacist. That reflects a time when people generally had one off bouts of illness. So infectious disease, or they fell off a ladder and sprained their ankle or something like that, they went to a doctor had a single episode of care, and were prescribed a single course of medicine, and the 30-day scripts make a lot of sense for that world.

Today's world is quite different. And what we're trying to do is remake Medicare to reflect the fact that people tend to have chronic disease now - so ongoing disease that might last for the rest of their lives, certainly for years and decades. And we're trying to move Medicare from a system based around single episodes of care between a doctor and a patient, to more continuous wraparound care by teams of primary care professionals: doctors, nurses, allied health professionals. In medicines, it doesn't make sense for people who are on the same medicine, year in year out, decade in decade out, or even for the rest of their lives, so, for blood pressure, high cholesterol for chronic diabetes, and a range of other conditions, to have to go back to the pharmacist every month, they have to go back to the GP regularly to get a routine repeat script.


That's why so many countries have moved to 60, or even 90-day scripts for these chronic conditions - not for everything, but for chronic conditions. And that was the advice of the medicines experts who manage our Pharmaceutical Benefits Scheme, or PBS. That was the advice they gave to the former government five years ago: “well, this is what European, North American countries do, the UK, New Zealand has done for 20 years, we should do it here.” And the former government decided not to proceed with that, we took a decision to do it.

So now doctors from the 1st of September for the first tranche of 100 or so different medicines – they’ll be hypertension, high cholesterol, those sorts of things - doctors will be able to issue a script for 60 days. And you'll be able to take that script now to a chemist and get 60-days’ supply of medicines for the price of a single script. So, effectively halving the cost of these medicines for those patients - we think about six million patients will be covered by this new system – can get 60-day scripts - so halve the cost of those of those medicines for them. But it also frees up millions of consults - millions of GP consults - that we know are desperately needed out there for serious health conditions. Currently, these consults are taken up with doctors issuing routine repeat scripts, and they want those freed up so that they can actually care for patients who are having trouble getting into their rooms. That's why every doctors’ group has supported this measure very, very strongly; they know it will be good for health, they know will be good for clearing their waiting lists.


KARP: Now, pharmacists have warned that this could force them to raise prices for other services like filling Webster medicine packs. Is it fair enough that if you're asking them to do more to make up for the loss of dispensing fees, that there might be an impact on the price or quality of services that they offer?


BUTLER: Businesses will make decisions on prices of various services they offer - or retail products they offer – that might mark up some of those retail products that are a big part of many chemists' operations now, they'll do that. Some of these suggestions have been, I think, self-serving, some have been plain wrong. For example, earlier this week, there was a big scare campaign that the Pharmacy Guild ran through The Australian newspaper that aged care residents might be charged $800 a year for their Webster pack. These are the packages of tablets that ensure that people get the right medicine, at the right dose, at the right time. Very common in aged care facilities. They ignored the fact that aged care facilities are funded to do that work: to do the packaging of medicines. And there's a specific legal prohibition against charging aged care residents for it. So, it was not only was self-serving, it was frankly false. And I'm sure the Guild knew that, I'm sure the Coalition – well, they should have known that - and they proceeded with this scare campaign against older Australians, nonetheless. I was particularly angry about that. The Guild is funded to do dose administration aid, or Webster packs for other members of the community, they get paid for that under the Community Pharmacy Agreement that they signed with the former government, but they'll make decisions about how their businesses operate. What we're focused on is a proper arrangement for medicine prescriptions for people with ongoing health conditions, giving them that cost of living relief, and giving that relief also to the health system to free up those millions of GP consults.

This will have an impact on pharmacy businesses, but it shouldn't be overstated. An industry that earns about $100 billion every four years will lose $1 billion, or bit over $1 billion - so 1% of that revenue from the Commonwealth. So, we will save $1.2 billion as a Commonwealth Government on behalf of taxpayers. But I've said that we would reinvest every single dollar of that into back into pharmacy. So effectively, it just goes back into pharmacy for other programs expanding their ability to give vaccinations and a range of other things. They will also lose some income from customer fees, our estimate of that is it will be about $1.6 billion over the four years, so about 1.6% of their revenue. So, not nothing - but the idea this is going to be cataclysmic for the pharmacy industry is frankly overblown. I said today, they made this claim seven years ago when the former government made a relatively modest change to medicine pricing arrangements. They said hundreds of pharmacies would close, there'd be widespread job losses, they issued a report from Henry Ergas who did a report for them again this year, and none of it happened. There was huge growth in the pharmacy sector after that, there's been 30% growth over the last four years. And the industry's own figures show that the average gross profit for pharmacies is 34% per year, there is not another part of the private medical services industry that earns a profit of 34%. So, I'm not suggesting this is nothing in terms of the impact on revenue, but frankly, this is a healthy, highly profitable, highly protected sector of the economy that I'm confident can adjust to this new arrangement and have a vibrant future.


KARP: Now the Coalition asked for a pause on 60-day dispensing and you said no. Then on Thursday the Senate voted down their disallowance motion. Will these changes now definitely take effect from the 1st of September, and what would happen if the Coalition came back and tried the same thing again in the week of the 4th of September?


BUTLER: They will certainly take effect on the 1st of September. It's really gob-smacking to me that the Coalition would continue to try to block access to these cheaper medicines for 6 million patients. But that's what they did on the Wednesday of the last parliamentary sitting week - so yesterday, when we're recording this - along with Pauline Hanson. And today the Senate voted on that motion, and the majority of the Senate supported our measure, so it will go ahead on the 1st of September.

Now, I understand that Anne Ruston, the Shadow Health Minister is intending to lodge another motion to try and block this again, that obviously can't be dealt with until after the measure has already taken effect. The legal chaos that that would unleash on thousands of general practices and pharmacies, and more importantly, millions of patients, really boggles my mind. So, after the circus of the last couple of days, and after the clear expression of the will of the Senate, why the Coalition would want to continue to stand alongside the pharmacy lobby instead of alongside patients and try and scuttle this really important cost of living measure is beyond me.


KARP: You brought forward negotiations for the next Community Pharmacy Agreement, how will that help when the changes are going to go ahead on the 1st of September?


BUTLER: The pharmacy industry generally, so the Guild, but other players in the pharmacy sector said the new agreement doesn't take effect at the moment until after 2025. And there's a lot happening in the pharmacy industry. Obviously, there's what we've introduced by way of 60-day prescriptions for some medicines, but there's also a lot of movement in around what pharmacists are able to do by way of delivering services. There are different pilots underway around the country around them doing more vaccinations, them potentially even prescribing medicines for urinary tract infections, or the common contraceptive pill and things like that. There's a comprehensive review of what we call scope of practice: what nurses are allowed to do, what pharmacists are allowed to do, what paramedics are allowed to do, those sorts of things. There's a comprehensive national review of all of that stuff happening over the course of this year and next. And so, I think they said, quite reasonably: “look, let's bring forward the negotiation of the Agreement so that there's some certainty over the next few years about how those new arrangements roll out.” We said we're open to that and so we agreed to bring forward the negotiations.


KARP: One of the earliest claims the Pharmacy Guild made in their campaign was that this would exacerbate medicine shortages. Do you want to respond to the claim that 60-day dispensing does that, and what are the real causes of those shortages?


BUTLER: There have always been periodic shortages in some medicines – and going back, they were aggravated during COVID, supply lines were shut down during COVID. We saw shortages of a whole range of things, including some medicines. We rely upon a lot of overseas manufacturing for many of our medicines, sometimes there is an inevitable shortage, that usually is part of a global shortage. So, it's not just something that impacts Australians. But the idea that 60-day prescriptions would lead to more shortages doesn't really stand the test of any analysis. So if you, for example, Paul, are on one of these medicines, you'll take 365 tablets during the year - if you're good about taking your medicines - you will take 365 tablets a year, whether you get twelve 30-day scripts, or whether you get six 60-day scripts won't change the amount of medicine that's going through the system.

The idea of a shortage just really doesn't stand up to any serious analysis. But it's also been rejected by the authorities that we have in place to manage medicines supply. The Advisory Committee for the PBS, they considered the claims, and they rejected them outright. Other people who are experts in the area and have responsibility for managing medicines supply, have also rejected the idea – the, frankly, pretty illogical idea - that providing the same amount of medicine through 60-day instead of 30-day scripts is somehow going to lead to a shortage.


KARP: Is there an outlook for, you know, those shortages improving, though?


BUTLER: They are, but some of them are subject to the shutdown of supply lines and manufacturing during COVID. Some of them, as many of your listeners would know if they've been following this debate, are subject to stuff which is, frankly, out of all of our controls. So, some of your listeners might be familiar with the debate around Ozempic, which is a really important drug for diabetes. It just exploded after some coverage about what it might do for weight loss, and so it was being prescribed right around the world – this is not just an Australian issue - right around the world for weight loss, rather than for people who were needing it for diabetes, ongoing diabetes conditions. So there did end up a global shortage of Ozempic, which all countries were grappling with, which really worryingly started to impact the treatment of people with chronic diabetes.

We worked very closely with the TGA, and the Americans and the Europeans were doing the same in their country. There are some of these things that are beyond the control of any single country, but then the medicines authority - in our case, the Therapeutic Goods Administration - will work very hard with the companies to try and relieve that shortage very, very quickly. For example, they've issued quite clear advice to doctors, really advising them that the supplier we do have in this country of Ozempic for example, needs to be prioritised for people with chronic diabetes, rather than used off label for people who have weight loss ambitions. I think that – we’re going off on a tangent here, Paul, I'm sorry about this - there’s a lot of development now and research about these medicines, and what they can do for substantial weight loss, and I think we're all watching that closely. But right now, our priority is using that medicine for people with diabetes.


KARP: A few months ago you spoke to the National Press Club about your crackdown on vaping. How are discussions going with the states around legislation there? And when will we see those changes in effect?


BUTLER: They are going very well, there's a really strong consensus right across the country to take really clear and strong action to stamp out the recreational use of these vapes, which are so clearly targeted at young people. And by that I mean very young people, in some cases, kids at primary school. We're working hard both across Commonwealth agencies, but also with our states, to determine the best legal response. I think our preference would be to be able to deal with this through Commonwealth legislation, rather than every single jurisdiction having to go through a parliamentary process, that would be the quickest and most efficient way. We're obviously having to work through those legal issues across agencies and across jurisdictions. I'm really pushing them, though.

I want to be able to be very clear with the Australian people, with parents with school communities, very soon about exactly what we're going to do to stamp this out. Already, you'll see in media reports that different states are already taking action to surge their efforts in starting to shut down some of these operations that are so clearly marketed to kids - some of these vape stores that are purposely opened up down the road from schools. Because they know that's their market. We've got more to do. We're very committed to additional resourcing for Border Force, because we as the Commonwealth have to do what we can to shut these things down at the border. But also, our health authorities like the TGA, equivalent health authorities at state level need to take action as well, and we're committed as a group of governments to doing that.


KARP: I also wanted to get an update on the rollout of Urgent Care Clinics, you've been chipped by the RMIT ABC Promise Tracker for not having them up and running at the start of this financial year. And there are also criticisms that are emerging that they're not open around the clock. Is that something that's going to improve in the near future?


BUTLER: I'm not sure I've seen that fact checker, but I could probably point to 30 to 40 different transcripts where I've said that these would be opened over the course of calendar 2023. Going back to the election campaign when we first announced it, I remember spending time with David Speers on Insiders on this, and I've repeated that over the course of the last 12 months. I think at the moment around 17 or 18 are open, but they're opening every few days at the moment, so, I might have that figure wrong, there might be more than that. And we're very clear, we're going to be able to open now more than 50 of these Urgent Care Clinics over the course of 2023. So, they are not all open now, but they are progressively being opened as I've promised, consistently, over the last 12 months. Some of them are not yet open the hours that we've indicated we need them to open -  that's 8am to 10pm, seven days a week. But I think reasonable people understand that sometimes you can't just click a new service on operating at full hours. Hospitals are having trouble getting nurses and doctors, general practices are having trouble getting nurses and doctors, these urgent care services are not necessarily all able to switch on seven days a week, 14 hours a day operations, from day one. They are all committed and contracted to do that over time. And we're working with them on ways in which we can assist them with recruitment of workforce.

The general feedback I'm getting from them is there's real enthusiasm among doctors and nurses to work in these services - they’re seen as interesting, exciting work. And even when they're located out in suburban areas, or regional areas where there's often quite difficulty recruiting medical and nursing workforce, the providers are saying to me that they've got a lot of interest.


KARP: That might be all we have time for. Thank you for joining us, Minister Butler.


BUTLER: Thanks, Paul.

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