Minister for Health and Aged Care - press conference - 29 June 2023

Read the transcript for Minister Butler's press conference in Melbourne on new PBS listing Kerendia; diabetes; cheaper medicines; voluntary assisted dying; women's reproductive health; First Nations health outcomes.

The Hon Mark Butler MP
Minister for Health and Aged Care

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MINISTER FOR HEALTH AND AGED CARE, MARK BUTLER: Thanks for coming out. I’m delighted to be joined by a number of guests, Diabetes Australia, you’ll be hearing from Justine Cain the CEO of Diabetes Australia and Professor MacIsaac, who led the Australian component of the international clinical trial that led to the listing of this extraordinary medicine Kerendia. We’ve also been talking with Neil, I think he's already talked to you about the life changing nature of this medicine. I want to thank St. Vincent's Hospital for hosting us here today.


When we came to Government, we promised to deliver cheaper medicines to the Australian community. And we've delivered on that promise on a number of occasions already in our first 12 months, most notably with the biggest cut to the price of medicines in the 75-year history of the PBS on the 1st of January. Already, that's delivered savings to Australian households of more than $100 million in just the first five months of that policy. And as people know, we're also committed to introducing 60 days of dispensing for more than 300 common medicines for chronic disease which will halve the cost of medicines for about 6 million patients who are often on medicines not just for years, but potentially for their entire lives, and dispense with the need for them to have to go back to GPs as regularly as they currently do to get a routine, repeat script. If they have to go to a pharmacy every month, and shell out money for a medicine that the Pharmaceutical Benefits Advisory Committee now for five years has said should be able to be dispensed for longer periods of time, bringing us into line with most countries to which we usually compare ourselves: New Zealand, European countries, North America, the UK and more.


We've also been delighted to be able to list new cutting-edge medicines on the PBS to make them affordable for Australian patients, but most importantly, to transform their life opportunities, to change their lives and in many cases to save their lives. Today, I'm delighted to announce another new listing that will take effect on Saturday, the listing of an extraordinary new drug Kerendia, which is a great new treatment for the many Australians unfortunately, who are dealing with diabetic kidney disease - what the clinicians called the deadly duo of Type 2 Diabetes and progressive kidney disease, which ultimately can lead to kidney failure. This new oral medication will slow kidney disease or the decline of kidney function to a point where patients aren't required to start to undertake dialysis several times a week - obviously something that really transforms people's lives for the worse, and is a very expensive treatment, usually in hospital, for the health system. I’m delighted that this new listing will mean that every year about 26,000 patients will have access to this new lifechanging treatment, which would otherwise have cost them $1,000 per year. Now, listed on the PBS the most a patient will pay is $30 for a script and if there are a concessional payment, it will be just $7 a script. This has been a great new advance in treatment. We live through this turbocharged period of discovery right now, where almost every month, new treatments for common conditions like diabetes and so many more are being presented by clinicians, by researchers to governments and the community as new chances at life for many, many thousands of patients. As I said in my introduction, Professor MacIsaac here at St. Vincent's in Melbourne led the Australian teams who participated in an international clinical trial to bring this medicine, to prove the case, and to bring it to market for thousands of Australian patients and patients elsewhere in the world. I want to congratulate the Professor for that work and the support that he got from patients like Neil who were willing to participate in the clinical trial, but also from terrific advocacy organisations like Diabetes Australia. I might hand over to Justine and ask her and Professor MacIsaac to say a few words about this drug and then I'm happy to take questions on this, or other matters. Thanks very much. Oh sorry, Professor MacIsaac first.


DIRECTOR OF ENDOCRINOLOGY, ST. VINCENT’S HOSPITAL MELBOURNE, PROFESSOR RICHARD MACISAAC: The Minister has really done my job for me with his wonderful talk about the problem with diabetic kidney disease. But to start with, I just like to welcome everyone to this special day for people with diabetes, but especially like to thank the Federal Minister for Health and Aged Care, the Honourable Mark Butler; Justine Cain, Group CEO for Diabetes Australia, team members from Bayer who brought this medication to the market. And last, but not least, our acting CEO, Associate Professor Antony Tobin for being here today. We haven't done a Welcome to Country yet, but I would like to acknowledge any Aboriginal and Torres Strait Islander people present here today, and anyone with the lived experience of diabetes. It's important that I do this, because those group of peoples bear a disproportionately high burden of kidney disease in Australia. And indeed, one of our patients from St. Vincent's with diabetic kidney disease, Mr Neil Meaden is here today, accompanied by his wife, Jill. And I think it's important we talk about people like Neil, because that's a common bond that brings us all together today trying to get the best outcomes possible for our patients with diabetic kidney disease. And also, I'd like to acknowledge the members of the media that are here today to bring this good news story to the broader community. As we’ve already heard, we're here today for two reasons: to launch a new report from Diabetes Australia on chronic kidney disease in people with diabetes. I'm sure Justine will talk more about this report, when she comes up to speak after me. So why are we here to highlight the problem with diabetic kidney disease? We're here because diabetic kidney disease takes a huge toll on the health, both physical and mental, to people with diabetes. It also represents a massive health burden for our health system, especially for those progressing to kidney failure requiring dialysis and kidney transplantation. We need to do better and slowing down kidney function loss in people with diabetes, as diabetes is the leading cause of kidney failure requiring transplantation or dialysis in Australia. Also, the presence of diabetes greatly heightens the risk of a person suffering from vascular disease, something like a heart attack. So two reasons why it's very important to slow kidney function loss in people with diabetes. The Diabetes Australia report that we'll hear about in a moment, highlights the problem of diabetes and chronic kidney disease. It also outlines what effective treatments and medications are available in 2023 to slow the development and progression of kidney disease. But importantly, it also stresses that we need to do better in terms of screening and finding people with diabetic kidney disease. And this can be done with a simple blood test and obtaining a spot urine sample. But there is hope. The new medication that we're launching today, Kerendia, on the PBS, provides another treatment option to slow progressive kidney function loss in people with diabetes and prevent progression to kidney failure. An effect proven in a large international randomised control study that St Vincent's Hospital participated in. The new medications blocks the pathway we think is an important driver for the development of progression of diabetic kidney disease. Kerendia has a very large international clinical trial program to support its effectiveness in terms of slowing progression of kidney function loss, but it also has highlighted the importance of being able to do this in a safe and effective fashion. So we have a call to action from the report, we need to do better in terms of identifying people with diabetic kidney disease. And we also need to be better in terms of applying effective treatment strategies to slow kidney function loss. Thankfully, in the immediate future, Australians will have access to a medication that does just that. I thank everyone for attending today and supporting these important initiatives for people with diabetes and kidney disease.


GROUP CEO, DIABETES AUSTRALIA, JUSTINE CAIN: Today, I'm here to launch Saving Lives by Better Detecting Diabetes-Related Kidney Disease. This report has been done with Diabetes Australia and the Australian Centre for Accelerating Diabetes Innovation. It's a story that is alarming. It is a story that has tragedy. And it is a story of hope. We are in the middle of a diabetes epidemic. 1.5 million Australians living with diabetes and a projection for that to double by 2050. 330,000 Australians living with chronic kidney disease and tragically 10,000 individuals with chronic kidney failure. Chronic kidney failure brings with it massive changes in lifestyle. Five hours, three times a week, 52 weeks a year, 780 hours a week, in hospital, doing dialysis. 50 per cent of people on dialysis report significant depression, as do many of their carers. The cost to the health system are equally alarming: $2.9 billion across the Australian economy as a result of chronic kidney disease. $1.9 billion of that is related to chronic kidney failure, and the costs associated with treatment. But there is significant hope. We know that there is lots that we can do. We have world leading hospitals, world leading health professionals, and a world leading National Diabetes Services Scheme. We have the medications, we have the clinical guidelines, and we know who we need to target. We need to target those individuals, those 300,000 people that will be coming down the line, the next lot of people out of those 1.5 million Australians. We know that early detection leads to early intervention. And we know that we can prevent many, many, many people being diagnosed with a chronic kidney disease. For every single person who is diagnosed with chronic kidney disease, and then goes on to kidney failure: $182,000 per person. So if I looked at this part of the room and just grab five of you, there's a million dollars right there that we can save. And then times that over and over as we grow. As the epidemic grows, we need to change the numbers. We have excellent screening programs already available in Australia. We have bowel cancer screening, we have cervical cancer screening, we have breast cancer screening, we have lung cancer screening and activity happening. It is really important that we consider the options and what we can collectively do to change these numbers. And that's why we are going to do more work as Diabetes Australia, with the health professionals and the researchers to come up with the most affordable way to look at options for broader screening of the diabetes community. Thank you very much.


BUTLER: Any questions?


JOURNALIST: Justine was just talking there about the potential for a screening program. What support might you have for that? What? How might you be able to help make that happen?


BUTLER: We were just talking before about the report, which has only been released today. We'll obviously read the report very closely. As Justine said, though, it is clearly a strong focus of our government to identify and intervene as early as possible with a patient, particularly before they get to the point of needing acute care - for their sake, obviously, but also for the sake of the sustainability of the healthcare system. We have a really proud record in this country of good population-level screening programs. Justine mentioned a number of them. In the Budget in May, we funded the development of one of the world's first lung cancer screening programs. We also funded the extension of the heart health check, which is working so well at a primary care level to identify people at risk of heart disease. I'm delighted at the opportunity to work with Diabetes Australia on this concept. We've had a partnership with diabetes, the Australian Commonwealth Government of both political persuasions now for more than three decades, and I think that partnership has delivered some of the world's best diabetes services. I welcome the report. Obviously, I've not had the chance yet to read through it, but we'll work closely with Diabetes Australia on some of the concepts coming out of it.


JOURNALIST: In terms of Victoria, are you concerned that jobs are being cut in Victoria's public health units?


BUTLER: I've only seen some reports in the newspapers about that. I don't have direct knowledge about decisions taken by the Victorian Government on this. Obviously, across the country, there has been a response to the move from the emergency phase of the pandemic to something very different. I don't know the details of what's happened here in Victoria. So, I'm not in a position to comment.


JOURNALIST Do you think that it would make us less equipped for future major health emergencies?


BUTLER: I think all governments, I know when we talk as a group of Health Ministers, are determined to make sure that the country is prepared for the next pandemic. That's why we're working so closely on the development of our election commitment to put in place a Center for Disease Control. We're currently the only OECD country that doesn't have a CDC. All states, including Victoria and the Commonwealth, are working very closely together to make sure that we can put that united system in place to be prepared for the next pandemic and to learn the lessons of the one that we've been dealing with over the last three and a half years.


JOURNALIST: Now it's no secret that many pharmacies, particularly in regional areas, aren't too happy with the 60-day dispensing changes. You've said that you would commit extra support to ensure that regional pharmacies don't shut down. But can you ensure that they won't be worse off come these changes, later this year?


BUTLER: This is a really important health measure that we announced at the last Budget. It will cut the price of medicines for 6 million Australians who are on common medicines for chronic disease: people who might be on these medicines for many, many years. It brings us into line, as I said earlier, with most other countries to which we usually compare ourselves. That's why it's been so strongly welcomed by pretty much every single patient group in the country, particularly those patient groups who represent Australians with chronic disease. They know it will cut the cut the number of times they need to go back to a GP just for a routine, repeat scripts. It will free up millions of GP consults every year, so that people with really substantial health care needs can get in to see their GP. Instead of having those appointments taken up for a routine, repeat script. As I said, it will cut the price of medicines. This is good for hip pockets, but it's also good for people's health. We know from overseas experience, where countries have these longer-term dispensing arrangements, that you get about a 20 per cent improvement in medication compliance. That's because the time at which people are most likely to go off their meds is when their script has run out. So reducing the number of scripts people have over a given year is also going to be good for their health. Now, every single dollar that the Commonwealth saves from this measure, at $1.2 billion, will be reinvested back into community pharmacy.


JOURANLIST: Just one follow up, you’re saying there it will cut the cost to patients and patient groups are quite happy. It could also cut how many regional pharmacies are opening, change their opening hours, cause some to shut down. Do you share concerns that, at the very least, this could lead to medicine shortages, particularly in some of these regional communities?


BUTLER: As I've said a number of times, including over the last couple of days, we are determined to support the work of regional pharmacies. That's why we're working so closely with them, with local Members of Parliament across the crossbench as well as in my own Party about the particular challenges in small rural pharmacies. That will be the particular focus of the reinvestment that I've committed to since the Budget, and more details about that will be released in the future.


JOURNALIST: I wanted to ask you, what's your personal position on 14-year-olds being able to access voluntary assisted dying?


BUTLER: I'm in this press conference in my capacity as the health minister not a personal capacity. And as you know, voluntary assisted dying is a matter dealt with by states. And since we're able to pass legislation through the Commonwealth Parliament, by territory governments as well.


JOURNALIST: I just wanted to ask when it comes to terminations for Australia's women, I know Labor Party is very focused on equitable access between the cities and the regions. But there is a push for free, both surgical and medical terminations, to be offered across the country. What's your response?


BUTLER: We went to the last election with a commitment in principle to equitable access. Part of that is geographical, part of it is also socio-economic. It’s not just a question between the cities and rural Australia. But there are a range of other ways in which equitable access to maternal reproductive health services isn't a reality for so many Australian women. That's why we asked the Senate Committee to conduct an exhaustive inquiry into these questions. They received great feedback from the community, they conducted public hearings around Australia. And as you know, they only delivered a report in recent weeks that we are working our way through.


JOURNALIST: States and territories have different rules around terminations, different guidelines that they follow. Would you prefer to see a national outlook rather than each state and territory being different?


BUTLER: The Senate report that I just referred to, that was delivered a few weeks ago, dealt with the difference between different state and territory jurisdictions and had some recommendations about that. Obviously, the Commonwealth Government has limited power to enforce arrangements about that. But there were recommendations about a dialogue between the Commonwealth and state and territory governments to achieve better uniformity and equitable access across the country. And we're working our way through those recommendations.


JOURNALIST: Right now, is that something you think the government would support?


BUTLER: As I said, we're working our way through those recommendations.


JOURNALIST: In the 2019 election, there was that idea of making the funding for public hospitals contingent on the provision of termination services. Is that something that the government is considering again?


BUTLER: That was a policy at an election some time ago. It's not our policy now. It's not the policy we took to the last election. We asked the Senate Committee to conduct an exhaustive analysis of these issues, not just issues related to public hospital services, but as you know, issues around medical termination, access to primary care support. We got an exhaustive response from the community and a really thorough report from the Senate committee, and we're working our way through that.


JOURNALIST: There are higher rates of diabetes and kidney disease among indigenous people. What's being done, in particular, to help indigenous people living in remote areas who are facing these challenges?


BUTLER: Firstly, if you don't mind, can I just say - I've been talking a bit about this over recent days - later this year, Australians will have a chance to vote for constitutional recognition of First Nations people, and to give shape to that recognition through a Voice to the Parliament and to the government. I can't think of an area where that Voice - listening to the voices of Aboriginal and Torres Strait Islander people - is more important than in the area of health. Because we have been confronted as a community, as a parliament, as Health Ministers for so many years now, with the appalling evidence of the yawning gap between Indigenous and non-Indigenous health outcomes. In this area, for example, Indigenous Australians are more than seven times more likely to die of kidney failure than non-Indigenous Australians. And there are so many other statistics where Indigenous Australians are impacted differently by health. There are other areas where, frankly, only Indigenous Australians are impacted by certain health conditions, like rheumatic heart disease, for example. It's clear that, in spite of the best of intentions, very substantial investment, that the current approach isn't working. We need a new approach to work with community, to listen to community, by which I mean First Nations communities about better ways to intervene, to change behaviours, and to close that gap. And it's quite clear to me that this is one of the most stark areas of gap between Indigenous and non-Indigenous Australians. So that's got to be the path forward, in my view as the Health Minister. I want to hear from Aboriginal and Torres Strait Islander people through a constitutionally enshrined Voice to the Parliament about how to better deal with these gaps that we've been confronted with for so many years now. In the meantime, while at the last election, we committed also to 30 additional dialysis units, each of which would have four chairs. They will be overwhelmingly focused on remote communities outside of our major cities, where it is so difficult to get access to good quality services. We're working with state and territory governments, with other organisations that have a record of delivering those services already and in the process now of rolling out that commitment. Thanks very much.

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