Radio interview with Minister Butler and Gary Adshead, 6PR Mornings - 26 April 2023

Read the transcript of the radio interview with Minister Butler and Gary Adshead on cheaper medicines.

The Hon Mark Butler MP
Minister for Health and Aged Care

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GARY ADSHEAD, HOST: Thanks very much for your time, Minister.  


ADSHEAD: Just to start off with. This, I mean, you've kind of got in between a turf war now haven't you between the AMA and the Pharmacy Guild. Are you, you know, you've obviously had to listen to the arguments. In essence, she seemed to have gone the way of the Australian Medical Association - the doctors - as opposed to the pharmacists, why is it? 

BUTLER: No, I've gone the way of Australian patients. The Pharmaceutical Benefits Advisory Committee - and this is a body set up by legislation over decades to advise governments on how to manage the PBS - the Pharmaceutical Benefits Scheme. It advises on what medicines should be listed on the PBS for what conditions, what patient groups should get it, and what the dispensing arrangements in pharmacy should be. These are the most qualified experts on medicines in the country that we have, and governments over decades have taken their advice. They have advised the government that for a whole lot of common medicines that people take for chronic disease, so people will take often - and not only for years, but for decades - the same medicine that patients should be allowed to get two months' supply of those medicines from their pharmacy, rather than a current limit which is just one month. Now this is very common across the world, the UK and New Zealand, Germany, France, Canada, most of the US, many other countries besides. They offer two or even three months’ supply of these common medicines that people are on, as I said sometimes for years or even decades. Accepting that advice, which I have, means we’ll effectively halve the cost of medicines for 6 million Australian patients with chronic disease. Halve the number of times they have to travel to the pharmacy, which will be particularly beneficial for people in rural communities who often travel very long distances. It will halve the number of times they have to go into a GP to get a repeat script, taking real pressure of general practice, which we know is under real stress. So, I didn't choose the Pharmacy Guild, the pharmacy lobby’s side, or the AMA’s side. I listened to the advice from the experts and came down on a position that I think is in the best interest of Australian patients. 

ADSHEAD: What's your reaction then to the Pharmacy Guild saying that one thing you will increase is the risk of overdose? 

BUTLER: I'm not going to respond to such a grossly irresponsible accusation from the Guild. I'll say this, the Pharmaceutical Benefits Advisory Committee is the highest expert body charged with medicines policy in this country. They considered the safety profile of every medicine that will be made available for two months rather than one. They sought the advice of the chief psychiatrist of the country, who particularly looked at mental health medications. And frankly, a number of long standing - or long term mental health - medications are not on this list because of the safety profile. Also, you will only be able to get a two-month script if your treating doctor says that that's appropriate, so, they will obviously consider any risk profile as well. But I have to say this is a grossly irresponsible and pretty offensive scare campaign being run by the pharmacy lobby. And I would caution them because they and the media should know there are very strict guidelines about responsible reporting of these sorts of things, particularly methods of self-harm and suicide and I think some of this scare campaign over the last 24 or 48 hours has been grossly irresponsible. This has been overseen by the most qualified safety experts in medicines policy in our country, and of course they've taken account of all of those things. 

ADSHEAD: Okay, well, I'll put one other to you that the Pharmacy Guild have come up with, and that's that you're sort of creating a “Hunger Games” for prescription medicine because the availability just won't be there and to be able to have that much in stock will make it very difficult for pharmacies? 

BUTLER: I don’t think you have to think about this suggestion for more than a few minutes to realise how patently ridiculous it is. These are very stable medicines that people take on an ongoing basis. This is not going to change the number of tablets dispensed over a period of time at all. It'll be exactly the same number of tablets. Now, some people will come in and get two boxes rather than one. And they'll come in and do that at different times. So, yes, pharmacies will have to think about the way in which they arrange their supplies on their shelves. But we're phasing this in over the course of the next two years - it's not coming in next week – we're phasing it in over a period of this year and next year. We also have very strong supply arrangements in Australia. Wholesalers are paid by taxpayers to have arrangements in place that mean if a pharmacy is worried about the supply it has on the shelves, they can ring the wholesaler and the wholesaler is required to supply that medicine within 24 hours anywhere in the country. So, whether it's in the city, or in the country, or particularly rural areas, that 24-hour obligation rests with the wholesalers. But this idea that somehow this is going to change the number of tablets being dispensed, you don't have to think about it too long to realise how patently ridiculous it is. I saw the public health expert, Stephen Duckett, who will be known to many of your listeners, heavy commentator, a former head of the Department of Health federally, described it in the last few hours as a complete beat-up, completely ridiculous, and it is when you think about it for more than a few minutes. 

ADSHEAD: So, is behind it the issue that pharmacists would say that they will lose money because they won't see customers as regularly, or is that a nonsense? 

BUTLER: This will halve the cost of medicines for 6 million Australians, now, let's not just walk past that too quickly, in the time of real cost of living pressure, this will have the cost of medicines, often for very low income Australians who are on heart meds, cholesterol meds, blood pressure meds, cancer medication, for a very long period of time, halve the number of times they have to go to the doctor, halve the number of times they have to visit a pharmacist and halve their costs. This is an incredibly important cost of living measure. But we also know that the cheaper you make medicines, the more likely it is that people will get this script filled. The Bureau of Statistics has told us that almost a million Australians every year go without filling a script that their doctor has said is important for their health, because they can't afford it. That's why we've been so focused as a government on getting the price of medicines down because we know it's good for the hip pocket, but we also know it's good for health. One of the really critical times when people often go off their medication is at the end of their script, when they just can't get into a doctor to get a repeat script, or their lives are too busy to get into a pharmacist. So, what we've seen overseas is that these longer dispensing arrangements allow you to get two months' supply rather than just one month, to improve medication compliance – people taking their meds - by as much as 20%. It's a really important public health measure. 

ADSHEAD: And just finally if I can, slightly flip side argument, of course we know that the TGA are considering now whether or not to restrict the quantity of paracetamol that someone could obtain without having to go to a doctor. Now a lot of people called into the program when we discussed it and said: well, look, I'm just trying to manage my pain, why should I have to go through more visits to a doctor in order to get paracetamol for heaven's sake, and that's the flip side, isn't it? 

BUTLER: It’s not really, because the TGA considered a range of options around paracetamol, a whole lot of medicines safety experts raised some evidence that showed there were some safety concerns around large quantities of paracetamol being available over the counter. They considered whether or not to move to a position where you might need a script – so go to a doctor, get a prescription for paracetamol - and the TGA rejected that. Paracetamol will still be available over the counter, available at supermarkets, certainly available at your local pharmacy and that is not going to change. There just will be a change to the number of boxes you can buy at a single time. I think you know the pain groups – the groups that represent patients with chronic pain - have indicated they're much more comfortable with the fact that the TGA has not decided to require people to get a script for their paracetamol. That's very different, for example, to the position that TGA took some years ago around codeine. Many of your listeners will remember you used to be able to get codeine over the counter, just go into your pharmacy and get it over the counter without a prescription from your doctor. That changed, now you do need a script from your doctor. But that's not going to be the case for paracetamol. Paracetamol will still be available over the counter at your pharmacy and indeed at supermarkets. 

ADSHEAD: Appreciate you joining us to explain all that. Minister, thanks very much.  

BUTLER: Thanks, Gary. 


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