Radio interview with Minister Butler, 4BC – 24 March 2025

PETER FEGAN, HOST: Joining me on the line is the Health Minister, Mark Butler. Minister, always great to have your company.
 
MINISTER FOR HEALTH AND AGED CARE, MARK BUTLER: Good morning, Peter.
 
FEGAN: So, 466 days is in stark contrast to 90 days to get drugs subsidised in Australia. I think Australians could be forgiven for agreeing with the opposition here when it says the government failed to act on the PBS. What's your response to that?
 
BUTLER: It's too long. I've said that very clearly. It was 466 days when the last government was in office, too. It's not something that's particularly emerged over the last couple of years since we've been in office. But both of us, I think, have said there's got to be a better system. We have a system of assessing and then approving medicines for payment under the PBS that's pretty old. It's been around for some decades. It served us very well, but it's not really working for the scale and the complexity of medicines that are coming to market today. They're just of a different nature to the ones that the system was set up to deal with.
 
I conducted the first review in 30 years of our system. It reported last year. It reported well over 50 very significant recommendations. I've got a group now with patient groups and industry groups chaired by a very eminent person who's been involved in medicines for a long time, working right now through those recommendations, trying to prioritise them for government because these are big decisions. They're going to cost taxpayers a lot of money. Some of them might be seen as more important than others. I want to get a sense of that from patient groups as well as from industry: Where should we start in this incredibly complex process? But where we can all agree, is that average of 466 days is too long. We have one of the best medicine systems in the world. It delivers Australians the best medicines anywhere on the planet at affordable prices. But getting them through the system is taking too long. We all agree it should be better.
 
FEGAN: Minister, was that an apology?
 
BUTLER: It's an acknowledgement. I think this is something that's sort of crept up over many years.
 
FEGAN: It's not just on you, I know that, but I think it's an apology. I mean, you should be credited for it. If you are saying sorry, I think Australians will react and say, okay, well, let's get on with it?
 
BUTLER: I think if there are patients out there who are waiting for medicines to be approved and who are either paying top dollar for them or even worse, might not be getting the therapies that they wanted and need it and to that extent, as the Health Minister, of course, I am sorry for that. We want the system to work better but this is something that has sort of happened over time as the nature of medicines has really changed. They used to be pretty simple, small molecule things that were all of the same type, pretty much. The system we had in place to have a look at them and assess them and then approve them worked very well. Now, as many of your listeners will know, they're incredibly complex. They're amazing. They're solving problems and curing conditions that 10 or 20 years ago we would have thought would be unimaginable. But they're much more complex to approve. We need to have a system that is agile, that recognises that scale and complexity of all of these new medicines coming onto the market and gets them into people as quickly as possible and that's not happening right now.
 
FEGAN: Well, credit where credit's due, you ordered a Health Technology Assessment in 2022, and in 2024, it gave 50 recommendations to speed up approvals. But unfortunately, Minister, I've got a question why we're still sitting here in 2025, given what we've learnt and given that we've got 50 recommendations from a year ago, why are we sitting here scratching our heads? Why is it taking so long?
 
BUTLER: Because many of the recommendations are very big in terms of what the potential cost to taxpayers would be. There are different views within industry and among patient groups about which are the most important, which ones we should act on most quickly. I'll give you an example. One recommendation is to put in place a bridging fund. Taxpayers would put in half a billion or $1 billion into fund medicines before they'd been approved. And if they were approved, well, that was fine. And if they were not approved, well, it would essentially be a loss that taxpayers made on a medicine that they bet on that ultimately didn't square up to all of the conditions. Now, this is a fund that operates in some other countries. It's been quite hard to implement in countries.  
 
FEGAN: Is it a tax?
 
BUTLER: Like Germany. No, it's funded by taxes obviously. It's taxpayers put that money in. But there are different views within the sector among different companies and patient groups about whether that's the best way to go or whether we should just focus on speeding up approvals. And if we speed up approvals, we don't need a bridging fund. That's just one example of a debate within the sector. We want to get to the bottom of that. And so when we make decisions about what a system, which I hope is going to last for the next 30 years, that we get it right.

In the meantime, we are listing medicines every month. We've listed more than 300 since we came to government. Some of them, frankly long, long, overdue. Women's health medicines that had not been updated for decades; for contraception, for endometriosis, for menopause treatment. In the meantime, we've been acting pretty furiously to get as many medicines on the PBS as possible. At the same time, as your intro said, cutting the cost for consumers and patients about what they pay at the pharmacy counter.
 
FEGAN: Yeah, so a bridging funding. Just quickly on that bridging fund again, I mean, we don't make that decision though. That's a decision made by government. It's not going to a referendum. A bridging fund means that you'll just use taxpayer funded money and say, righto, we need to test out some new drugs, right?
 
BUTLER: Yeah, but the recommendation was to have a look at a bridging fund that would essentially have taxpayers fund the medicine that had not yet been approved. That's a big decision and when that went out there were different views, frankly, between companies about whether that should be a priority or not. Given the amount of money that taxpayers can spend on medicines, it's not a bottomless bucket, is that the best use of money or should we use the money on something else. That is the sort of thing this implementation group is working through. They’re reporting to me, or whoever the health minister is after the election in the next several months, and then government will have to really make some decisions about this. I think for the next term of parliament, this is one of the more important areas in the health portfolio that the next parliament has to deal with.
 
FEGAN: We're talking about the changes to the Pharmaceutical Benefits Scheme. In particular, the 466 days we have to wait now for subsidies to be placed on drugs when in stark contrast to other countries, it's around 90 days. Look, I'm interested in more broadly here, Minister, to get your thoughts on this and I was talking about this on the Today Show over the weekend. Donald Trump, I'd like to get your thoughts, have you spoken to the administration? Because I think in the back of a lot of Australians minds is a tariff on pharmaceuticals is not out of the question, is it really?
 
BUTLER: No, it appears to be very much on the table. Currently we sell about $2 billion of pharmaceuticals to the Americans. They sell about $3.5 billion to us. They do pretty well out of the trade on pharmaceuticals. They sell more to us than we sell to them. And at the moment it's free trade. It's tariff-free as part of our US Free Trade Agreement. And there clearly is some contemplation that they may, no decisions made, but they may put a tariff on those Australian exports. That's in the mix.
 
FEGAN: Okay, just on the 50 recommendations, before I let you go, something I want to get you on at the end. But 50 recommendations, have we implemented any yet?
 
BUTLER: No, all of them are really about system change. It's a package.
 
FEGAN: Okay, so none yet?
 
BUTLER: No, and I've been very clear. I don't want to cherry pick some of them. I think the review treated them as a package. Rather than cherry pick some that are relatively easy we need to work through them as a package and get the best possible advice about what we do next.
 
FEGAN: Wouldn't it be easier for the easiest ones just to go straight to be approved immediately? I don't know, I'm just guessing.
 
BUTLER: Not if they're not the ones that have best bang for buck. At the end of the day, we will be able to allocate resources to our medicine system. As I said, I think one of the best medicine systems in the world. And we want to be really sure that we're allocating money in the best possible way for patients.
 
FEGAN: Okay. Now, have you seen your diary this morning, Minister?
 
BUTLER: Yes, I have.
 
FEGAN: What are you doing Saturday, May 3rd?
 
BUTLER: At the moment, it's blank because all of the Saturdays in May are at the moment to be advised.
 
FEGAN: Okay, can you not do it on May 10th? I've got something booked in on May 10th. So can you do it May 3rd, please?
 
BUTLER: I think you're talking to the wrong bloke, Peter. I'm happy to pass it on, but at the end of the day, it's not my decision.
 
FEGAN: So I know you won't answer this, but if I was a betting man, would I suggest that perhaps the Governor General and the Prime Minister may see each other this weekend at some stage?
 
BUTLER: Again, I just don't know, Peter.
 
FEGAN: Okay.
 
BUTLER: We could endlessly speculate about exactly when that meeting is going to occur and when the election will be, but we know it will be in May at some time. And it's an important election, particularly for health policy in this country.
 
FEGAN: Good on you, Minister. Always great to have your company. We'll chat again very soon, no doubt.
 
BUTLER: Will do. Thanks, Peter.