Minister for Health and Aged Care's doorstop in Adelaide on 21 January 2024

Read the transcript from Minister Butler's doorstop covering cheaper medicines and bulk billing.

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 on a Sunday morning for this really important announcement. I'm joined by Owen Smith from Bristol Myers Squibb here today, who is responsible for the drug that we are listing on the PBS. Rachel, who works here as a medical oncologist at the wonderful Queen Elizabeth Hospital. Felicity and Tamara, who are patients and patient advocates, and they'll have something to say about this listing in due course.

First of all, can I say that we were elected 18 months ago on a promise, among other things, to strengthen Medicare and to make medicines cheaper, and we've been delivering over the course of that time on that promise. In 2022, we slashed the maximum amount that millions of pensioners and concession card holders would pay for all of their medicines needs by 25 per cent. So, pensioners, no matter how many medicines they're on across a given year, will only pay around $5 per week for all of those medicines needs. 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 slashing the price of general scripts by almost a third. In just 12 months, that measure alone has delivered $240 million in savings back into the pockets of general patients Tens and tens of thousands of general patients who are doing it tough in this global inflation crisis. Through the course of this year, that measure will continue to deliver around $20 million in savings each and every month. The third phase of our cheaper medicines policy was delivered in September when we finally delivered on a long-standing recommendation from medicines experts to allow certain common medicines that are prescribed to treat ongoing chronic conditions to be available for 60 day scripts. Over the last few months since that measure came into effect for about 100 medicines on the 1st of September, millions of dollars have also been saved by patients who are able to get medicines that they might be on not just for years, but for decades or the remainder of their life on a 60-day script instead of a 30-day script. Over the course of this year in 2024, further phases of cheaper medicines policy will also take effect on the 1st of March about another 100 medicines will be available for 60-days scripts. Then in September, another 100 medicines again will be available for 60-days scripts.

We know that cheaper medicines are not just good for a patient's hip pocket at this also good for their health. We know that almost a million patients each and every year, according to the Bureau of Statistics, go without a medicine that their doctor has said is important for their health because they simply can't afford it. It's not just good for hip pockets. driving down the cost of medicines is also good for the health of Australians.

I'm also delighted to say that through the course of these phases of cheaper medicines policy, we've been able to list dozens and dozens of new cutting-edge medicines on the Pharmaceutical Benefits Scheme. This means that Australian patients get access to the most cutting edge, most modern medicines for a variety of treatments at PBS prices, as I said around $30 a script at the most for a general patient and for a pensioner no more than about $7 a script.

Today I'm delighted to announce that from the 1st of February, a new cutting-edge immunotherapy for advanced melanoma will also be listed on the PBS. Opdualag, will treat around 940 patients each and every year who have advanced melanoma. Now melanoma, as I'm sure Rachel will explain much better than me, is tragically known as Australia's national cancer. Here in Australia, we have the highest rates in the world of melanoma with almost 20,000 patients each and every year, 20,000 Australians receiving a diagnosis of melanoma and more than 1,200 Australians tragically lose their lives each and every year. Around four Australians will die on average each and every day of melanoma. Now this latest cutting-edge treatment immunotherapy, Opdualag, will be available for patients who have melanoma that is not able to be removed surgically or has become metastatic. This will give new hope to almost 1,000 Australians each and every year and add a new tool to the growing toolbox of treatments for Australia's national cancer. I might hand over to Rachel to say a few more words.


MEDICAL ONCOLOGIST, ASSOCITAE PROFESSOR RACHEL ROBERTS-THOMSON: Thank you, Minister. Whilst melanoma prevention is really key in Australia, for patients with advanced melanoma having treatment options tailored to their needs is very, very important. Today's listing expands access to patients’ treatments with this diagnosis of advanced melanoma, and as a clinician treating patients with melanoma this announcement is really welcomed. Opdualag is a novel treatment. It consists of two immunotherapy drugs, one which we've had in the clinic for a while called Nivolumab and a new immunotherapy drug called Relatlimab. Together, the two immunotherapy treatments hope to replenish exhausted T-cells, so those T-cells can go on and treat the melanoma. It is a very welcomed announcement today for clinicians treating patients with melanoma.


MELANOMA PATIENT, FELICITY LLOYD: I'm Felicity Lloyd, I am a patient of Rachel's and have been now for over nine years with advanced melanoma. I was diagnosed with advanced melanoma that was clear for some time and then further advanced just after my daughter was born about six years ago. Access over that period of time to the types of medications that we're here talking about today has improved drastically. As a as a patient, that access and the options that these medications bring, not only bring hope, but in my case certainly have brought about a hope about a longer life and hopefully somewhat curative. So, I’m really excited to be here today. I was fortunate enough to be part of clinical trials, but also to have access to medication on the PBS compassionate access to other medications. As these medications are trialled and tested through the system, we really do have new hope for those like myself with advanced melanoma.


DIRECTOR OF MELANOMA AND SKIN CANCER ADVOCACY NETWORK, TAMARA DAWSON: I'm Tamara Dawson, I'm also a stage four melanoma patient. I'm also the founder of the Melanoma and Skin Cancer Advocacy Network, MSCAN. I just want to thank the Minister and the Government for providing access to new immunotherapy medicines for melanoma patients. I know there'll be many families around the country that have been impacted by a melanoma diagnosis that will be really grateful to hear this news. There's been incredible progress in the treatment landscape for both melanoma and skin cancer over the last decade. This is another really important step. And as the Minister said, we really do need more tools in the toolbox. As a stage four patient myself, I understand the importance of the science and the research and the clinical trials and then access to new medicines. And as the founder of MSCAN, I'm really pleased that we're able to advocate for this important medicine and really appreciate it that will be available for all Australians. Thanks.


BRISTOL MYERS SQUIBB (BMS) GENERAL MANAGER, OWEN SMITH: I’m Owen Smith, and I'm the managing director for Bristol Myers Squibb in Australia and New Zealand. All I want to do today is thank the Minister and his Government for the rapid listing we've seen for this important new treatment option and to say on behalf of Bristol Myers Squibb, a massive thank you to Tamara and to Felicity and to Rachel. Perhaps in particular to Felicity and Tamara for sharing their time and their story with us today. As we have heard already, there have been huge increases in the volume of treatments that we have available for patients such as Tamara and Felicity, we at BMS are incredibly proud of played a part in bringing these new cutting-edge immunotherapy treatments to market including the medicine that we are listing today. We’re very pleased to be here and delighted with this new option for clinicians and patients in Australia.


JOURNALIST: Can I ask about the telehealth diagnostics tool that's also coming along with this?


SMITH: Obviously, in Australia, where we have huge sparsity and very wide differences between both patients where they live and those clinicians who are treating them, we need to come up with new and innovative ways in which those patients can access cutting-edge clinicians such as Rachel and telehealth is obviously one of the ways in which we can do that. We've seen great advances in particular in the COVID period in adopting those sorts of new tools and technologies, and BMS, again, are committed to try and help bring those things to market.


JOURNALIST: In layman's terms is this an oral medication that's taken or is it more of a treatment?


SMITH: It's an infusion medicine. So as with lots of the immunotherapies, you'd see these infusion chairs in the clinic here today, patients would come in and receive the medicine in a morning or an afternoon as an infusion.


JOURNALIST: Is this drug available around the world and how long has this been around?


SMITH: It's only very recently been licensed in Australia and around the world. It was licensed in just October of 2022, in Australia by the TGA. The minister and the government have been incredibly speedy in dealing with the reimbursement process and getting that through PBAC and bringing it to patients. It's one of the first reimbursements and listings anywhere in the world. So Australia is leading the way.


JOURNALIST: Could you just explain how it actually does treat melanoma?


SMITH: As Rachel said a moment ago, it helps enable the body to fight the cancer, it reenergises the T-cells that are critical to the immune system, and it allows those that target the cancer and effectively help the body to recognise the cancer in ways in which it doesn't ordinarily,


JOURNALIST: Can you speak much to the success rate of this treatment so far?


SMITH: It's been very, very successful, which is why we proceed to get it licensed and reimbursed in Australia. It's a very important new tool for clinicians such as Rachel, who's probably far better place than me to talk to the end that clinical effects.

JOURNALIST: Rachel, I might just pose that same question to you. What have you seen the success rate for this treatment? I know, it's not on the PBS to February.

ROBERTS-THOMSON: I think we anticipate that this will be more effective than our single agent immunotherapy treatments. That's been bought out through phase two, and three clinical trials that have been run internationally. We're very much hoping this will show improved outcomes for our patients in terms of them living longer and doing better. It's another option for us to use when we have a patient sitting in front of us. We put several factors together and then having this option available is going to be very beneficial, because we can now use utilise this option for our patients.

JOURNALIST: Do you have patients here or nationally as well that come to mind for this treatment?

ROBERTS-THOMSON: Yes, I think there will probably be a few patients lining up, with their clinician, to start this treatment from the 1st of February.

JOURNALIST: Have you seen patients that are just foregoing treatment, that can save or prolong their lives because of the cost and how does that make you feel?

ROBERTS-THOMSON: I think with melanoma, we are lucky we do have options available funded through the pharmaceutical benefits scheme that are quite useful. But this is to us, to paraphrase, another tool in the toolbox. We do have some effective treatments already available that we can access but this is another treatment that we're hoping will improve upon, again, both outcomes for patients.

JOURNALIST: Felicity, have you used this treatment through compassionate grounds? Or is this something you haven't had access to before?

LLOYD: This particular immunotherapy was not one that was available when I was diagnosed, but I did utilise an immunotherapy. As those have talked about, I guess this is another tool in the toolbox. I was fortunate that the tools that were currently available at that time were worked for me. It's about continuously improving those tools and providing options when the current tools don't work or aren't viable.

JOURNALIST: Looking at the success rates of this treatment someone in your position six years ago, how much relief would that be that this is available now?

LLOYD: It's a huge relief. I think we've talked about it today that the treatment for advanced melanoma has improved significantly over the previous sort of decade or so. So as an early patient with advanced melanoma, my treatment options were quite slim, and certainly treatment options that were available on the Pharmaceutical Benefits Scheme were not really there. There was some but not a lot. My own treatment required quite a number of tools. I experienced first hand what it's like to have one treatment, partially work, but also need those further treatments to have a more successful outcome. As an advanced melanoma patient, just really excited to see that patients who are in that position will have another tool that their oncologists can suggest to work with them to a more successful outcome.

JOURNALIST: How stressful was it to go through this and then have to deal with thinking about whether you can afford it and then applying for compassionate grounds for PBS assistance?

LLOYD: It's very stressful. I don't think anyone can approach things on their own. So you have a team around you, you have your family, of course, and your great oncologist. I was fortunate that Rachel was my oncologist who helped me through how to navigate because the system and the processes to access the right medication for you. And stressful yes, of course, you've got an advanced cancer diagnosis but the more options that are available, decreases that stress and allows the patient to get on with getting better.

JOURNALIST: Could you just talk about, you know, when you're first diagnosed, and you said just after you've given birth to your child as well?

LLOYD: Yes, so I had stage three cancer prior, I'd been clear for some years, a number of years, and my husband and I decided it was time that we could try for a child. I was about 34 weeks pregnant when I found a lump in my left breast. At that time, I was going to go and have an ultrasound and have that looked at and my daughter came prematurely. So that was pushed back by a few weeks. About 10 days after she was born, I found out that that was melanoma and therefore it had spread. Of course, then there's a process to go through to work out how far that had spread, it was quite extensive in my case. And then you start to look at treatment options. Like I mentioned earlier, the fact that there had been clinical trials, and there was some medications on the PBS gave me options even at that time. As an advanced melanoma patient, of course, you read, you continue to follow the advances in the medications that are available to you. Over the past six years, we've seen more and more of that. I something were to occur, and my cancer were to return, these are the sorts of options that I'll be very, very grateful to have available to me.

JOURNALIST: Tamara, given that you have a background in the Advocacy Network, I guess how important is it just to remind people watching this tonight, how important prevention is as well?

DAWSON: That’s right, it has to start with skin cancer prevention. I think there's so much more that we can do in that space, particularly in summer to urge all Australians grab the hat, put the long sleeves on, we know that cancer council’s message. We really need to work hard in that space. I think there's so much more that we can do to prevent patients developing really serious types of cancer.

JOURNALIST: I guess from your perspective, as well, how much of a barrier is the cost of medicines for cancer patients?

DAWSON: Yeah, so it's a great question. I was diagnosed with metastatic melanoma almost nine years ago and it was just as the new immunotherapy treatments were coming online so I've been really fortunate that the medicines that I have needed have been PBS listed. I'm here because of the great advancements in medical science and these incredible new these new medicines and immunotherapy. I’ve been fortunate the cost of the medicines hasn't impacted my treatment plan.

JOURNALIST: As an advocate, are you seeing people not getting the medicine they need because of the cost?

DAWSON: No, I think the medicines for melanoma have been listed on the PBS when we've needed them to be listed. I think in terms of the immunotherapies, and targeted treatments for melanoma and skin cancer, we’re kind of leading the way in access to treatments for melanoma and skin cancer patients. I think that we've been fortunate to be able to access the medicines when we need them.

BUTLER: These immunotherapies are delivering really terrific increases in survival rates for melanoma among other cancers, but they are expensive. Without listing on the PBS, this medicine, for example, would cost around $315,000, for a course of treatment. Obviously, well beyond the means of almost every Australian which is why the PBS is such a treasured part of our health system.


JOURNALIST: On bulk billing, despite the Government's tripling the incentive for children and pensioners just 24 per cent of GP clinics are offering bulk billing. Is the Government considering expanding the incentive to all patients?


BUTLER: I don't think that data point is completely right. What that data point measures is how many GP practices are bulk billing every single patient that walks through their door for every single service. Actually the data that we've published most recently indicates that a little more than 70 per cent - I think around 73 per cent of GP consultations, are bulk billed. Now we want to see that increase, which is why we tripled the bulk billing incentive on the 1st of November, the biggest investment in the history of bulk billing in Medicare. This is something we want to see increase particularly for vulnerable Australians, pensioners, concession card holders, children under the age of 16. We're very confident that that increase in the bulk billing incentive the tripling of the incentive, $3.5 billion dollar investment by taxpayers into Medicare will start to have an impact.


JOURNALIST: Also, the Royal Australian College for General Practice is concerned that too many patients are moving towards private, private billing. Are you looking at ways to modernise Medicare to avoid that?


BUTLER: The College, to their credit, has been making that case now for a few years. Bulk billing has been in decline for a period of time now and largely as a result of the cuts and neglect we saw over the last decade to Medicare, particularly the six year freeze of the Medicare rebate that was initiated by Peter Dutton when he was the Health Minister. The College argued for the Government to triple the bulk billing incentive and that's exactly what we did in the May Budget last year. We know that they and their members want to bulk bill as many patients as possible but particularly want to bulk bill vulnerable Australians who are on the pension, who have a health card or children which is why we tripled the bulk billing incentive for that group in particular.


JOURNALIST: The fuel excise is about 50 cents a litre, will be Government cut the excise to give motorists relief?


BUTLER: The Prime Minister and the Treasurer have pointed to the $23 billion in cost-of-living relief that we delivered to households last year, very carefully designed to make sure that they helped households with this global inflation shock while also not adding further pressure to inflation. It covered areas like cheaper medicines, more free visits to the doctor, cheaper childcare, free TAFE, energy bill relief and much more. The fuel excise was reduced for a very temporary period, initiated by the former Liberal Government legislated to come to an end in September 2022 from recollection. That was the decision taken by the former government.


JOURNALIST: As was reported yesterday, ministers are coming in early next week to discuss more cost-of-living relief, what will that agenda look like?


BUTLER: The full caucus is coming back together on Wednesday to hear from the Prime Minister and discuss our plans for 2024. As I said, we did a lot of work last year including $23 billion in targeted cost of living relief for households. But we also recognise, and the Prime Minister has said there's obviously more for us to do through 2024. He's commissioned Treasury and Finance to put together further proposals for cost-of-living relief. We have other measures that are already legislated to take effect over the course of the 2024 and I know that all my caucus colleagues are keen and raring to get going with delivering again for Australians this year, which is why we're coming together in Canberra on Wednesday.


JOURNALIST: How can the public be assured that serious actions will be taken?


BUTLER: Well, we're coming together early. The Prime Minister has called his caucus colleagues together this week even though parliament doesn't commence again for a couple of weeks, because we recognise Australians are doing it tough. We delivered substantial relief over the course of 2023 but we know there is more to do in 2024 and we're determined to get going as quickly as possible with that.


JOURNALIST: Just on the topic of this presser today, how will the changes to the PBS help?


BUTLER: Cutting the cost of medicines, as I said earlier, it's not just good for an individual's hip pocket, it's good for their health. It also reduces pressure on inflation as we start to see the price of this everyday good start to come down. We've ticked a number of boxes with our cheaper medicines policy. I'm confident it's going to have significant benefits for people's public health. But also importantly, at a time of a global inflation shock, it really relieves some of the pressure on household budgets


JOURNALIST: On the Better Access program, when will you reform that it's been over a year now, since you promised steps to improve it. Will this has happened this year?


BUTLER: I'm really glad to see that tens of thousands, more Australians got access to psychological therapy last year than they had the year before. Because of the very temporary changes that the former government made as a COVID measure, budgeted to come to an end on the 31st of December 2022, we saw more people get access to therapy. We saw an evaluation of that program demonstrate very clearly that the additional sessions that we put in place for the COVID period had the effect as many predicted it would have the effect of cutting off any access for tens and tens of thousands of Australians, mainly from poor communities in our major cities, the outer suburbs of our major cities and rural and regional Australia. I said at the time that I wanted to see through 2023 is more Australians who needed to gain access to psychological therapy and around 45,000 more Australians were able to see a psychologist last year compared to 2022. That's exactly the objective that I had at the beginning of the year. There is more to do in the area of better access, which is the major Medicare scheme for psychological therapy. It's not an equitable scheme in the sense that it doesn't provide good levels of psychological therapy in poorer communities, or in rural and regional Australia. It's also not a scheme which the evaluation showed was really working for people with more serious and complex mental disorders. I'm working with representatives from the sector on ways in which we can deal with both of those issues in particular, and we'll have more to say in due course.


JOURNALIST: Do you know if that scheme has become more or less expensive, because there are figures from the Department that fewer sessions are being accessed?


BUTLER: I'm not sure what data you're referring to, because around 45,000 more patients accessed this scheme last year compared to 2022.


JOURNALIST: Does the government plan to announce some cost-of-living relief before the end of the week?


BUTLER: That's a matter for the Prime Minister. We're keen to get going on this, which is why the Prime Minister has called caucus back together, we're proud of the measures that particularly the Prime Minister and Treasury delivered over the course of 2023 but recognise there's more to do in this global inflation shock that is hitting Australian households hard.

JOURNALIST: Has Treasury given the government a list of cost-of-living relief options and if so how many?


BUTLER: That's a matter for the Prime Minister and the Treasurer.


JOURNALIST: Power prices have been kept lower through the $3 billion dollar energy bill relief funds. Will this be extended beyond June 30?


BUTLER: You're right to say that the Bureau of Statistics showed very, very clearly that the energy bill relief that our government put in place in concert with all of the state and territory governments, opposed by Peter Dutton, it must be said has had a really serious impact on energy bills because of the energy shock that we've seen around the country through the illegal invasion by Russia of Ukraine, the Middle East crisis, energy bills were going to go up very, very significantly over the course of 2023. We were able to make a real impact on that through our energy bill relief. As to particular measures that might or might not be considered by the Prime Minister and Treasurer, I can't comment.


JOURNALIST: Just a question from our Melbourne Bureau, pro Palestine protesters are blocking the Port of Melbourne for the third day running demanding an Israeli company that is shipping be refused entrance. It's an ongoing issue at ports around Australia. What are we going to do about this?

BUTLER: Ours is a vibrant democracy, and perhaps the most successful multicultural nation on the face of the planet, and that includes in it a right to peaceful protests, but I do urge Australians through a really difficult period that the world is facing right now, to remember just how important social cohesion is and the fact that protest should be peaceful and lawful is to the success of our nation.

JOURNALIST: Will the government engage with these protesters, and does it support them?

BUTLER: I don't have anything to add to what I just said.

JOURNALIST: Do you condemn the protests?

BUTLER: I'm not aware of every detail of the protests. I do say it's a long-standing position of our government protests should be peaceful, it should be lawful, and it should be respectful of the social cohesion that has helped make Australia such a successful nation. Thanks, everyone.


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