Radio interview with Minister Butler and Nadia Mitsopoulos, ABC WA Mornings - 27 April 2023

Read the transcript of Minister Butler's interview with Nadia Mitsopoulos on cheaper medicines and COVID-19 vaccines.

The Hon Mark Butler MP
Minister for Health and Aged Care

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NADIA MITSOPOULOS, HOST: Minister, good morning and thank you for your time. 


MITSOPOULOS: You say this move will save consumers $1.6 billion over 4 years. Can you just explain how they get that saving? 

BUTLER: Every time, as you obviously know as well, I'm sure, every time you go to a pharmacy to pick up some medicine, you have to pay a co-payment. So for general patients that might be $30 per script, and for pensioners and concession card holders it will be about $7. If you are only able to get 30 days’ supply of medicine it means if you're on a chronic disease medicine, some of your listeners will be on the same medicine not only just for years but sometimes for decades, and every month, you are going back to the pharmacy and you're shelling out a co-payment. You're having to go back to a GP at least a couple of times a year to get a repeat script.  

The advice that I received from the expert group charged with running our medicine system, our PBS system in particular, advised me that for more than 300 of these very stable medicines, you should be able to get 60 days' supply. And this is very common across the world. Most countries that we would usually compare ourselves to have had these arrangements in place for many years. Some of them have 90 days’ supply. I was actually advised by the Advisory Committee that we could go to 90 days supply, but we've decided that 60 days is the right balance. So halving the cost of medicines for 6 million Australians who live with chronic disease, and many of them will be low income, or pensioner Australians and this will be a very substantial cost of living relief for them, but also good for their health, because we know that a lot of the non-compliance with medication - where you go off your medicine, go off your tablets - happens when you run out, or happens when you need a repeat script and find it difficult to get back in to see a GP. Evidence from overseas in countries that have these systems shows it improves medication compliance by up to 20 per cent, so its not only good for the hip pocket, it's also good for health. 

MITSOPOULOS: And if I can just clarify on the cost, Minister. Would I be paying the exact same amount for 60 days' worth of medication as I would for 30 days? Is it twice the amount of medication for the same price? 

BUTLER: If it's up at the co-payment limit. So for a pensioner, if the most you'll pay is $7 whenever you go into a pharmacy, so if you get 30 days' supply or 60 days' supply, you pay $7. For general patients, the figure is $30. So that's really where the saving to patients comes. You're getting twice the supply for one co-payment. 

MITSOPOULOS: Okay. Pharmacists say this move will drive them out of business because of that loss of income there. Do you buy that argument? 

BUTLER: I don't buy it. I mean, I take it very seriously, because I am absolutely committed to a thriving, sustainable community pharmacy sector. We will also make some savings as a government from this because every time a box of tablets crosses a counter, we pay a fee to the pharmacist. So we’ll also save about $1.2 billion as a government on behalf of taxpayers, and I committed yesterday that every single one of those dollars will be reinvested back in the community pharmacy programs, with them delivering more services to their customers rather than just really processing repeat scripts. 

MITSOPOULOS: So then how does that work, what sort of programs? And how do pharmacists have to apply for that money, how will that work? 

BUTLER: We’ll be providing more details of those programs over the coming few days, but pharmacy groups have been telling me for as long as I've been involved in the health sector, they want to deliver more services. They don't just want to be dispensing medicines which is obviously a critical part of their job, a valuable part of their job. These are highly qualified health professionals and they can - we saw through COVID - deliver great vaccination services. Whenever I go into a pharmacy there is usually someone there asking the pharmacist for health advice, particularly when it's so hard to get in to see a GP. So not just the Commonwealth Government, but I know all state governments as well, including over in WA, I know, are committed to seeing whether we can find more things, more services that pharmacies can provide to their customers as patients, as genuine health professionals, rather than just dispensers of medicines.  

MITSOPOULOS: Doctors won’t like that. I mean I appreciate it's about freeing up GPs, but GPs won't like that.  

BUTLER: There’s always, I can say in the health sector, fairly furious debate about what particular groups of health professionals should and shouldn’t be doing. Ultimately we have to make the best clinical decision in the interests of patients and I'm determined to do that. But we step through these questions very carefully to make sure that the paramount issue of patient safety is preserved, is safeguarded by whatever changes happen. I think at a time - generally as a general proposition - at a time when demand for healthcare is soaring and it will continue to increase, we're a population that is getting older, we’re a population with more chronic disease so we can expect that demand for healthcare is not going to reduce any time soon.  

And a time when workforce is hard to come by it just doesn't make sense, not to have every world trained health professional using their full range of skills, using what they call their scope of practice, and we don't do that in Australia. We don't let nurses do everything that they are trained to do. We often don't let pharmacists do everything they're trained to do as well, so having everyone operate to their full range or at the top of their scope of practice is something I'm really keen to do. And, frankly, it was also a very clear message from the Strengthening Medicare Taskforce, which is a group of doctor’s groups, nursing groups, patient groups, other health groups that I convened over the second half of last year to advise the Federal Government on what we could do to strengthen Medicare. A very clear recommendation was use your health professional in a smarter way. There's just too much, too many limits on the things that our world qualified health professionals can do.  

MITSOPOULOS: 325 medicines that will be included in this change - and it is a transition period, you'll stage it - but diabetes, sort of heart disease, will antidepressants and sort of those mental health medications be included?  

BUTLER: Some are, some aren't. So the Advisory Committee for Pharmaceutical Benefits has gone through all of the medicines on the PBS, conducted a risk assessment for every medicine, and also taken advice from the Commonwealth’s Chief Psychiatrist, particularly, obviously, about mental health medications. The list is available on the PBS website for people who want to go and have a look at it but there are some some ongoing mental health or psychiatric medications that are not included on the list because of safety considerations, on the advice of the Chief Psychiatrist. The important thing though is that there really has been a very strong safety assessment conducted of these medicines, and as a further safeguard people or patients will only be given a 60 day script for a medicine, whether it's a cholesterol med or diabetes med or an antidepressant. They'll only be given a 60 day script if their treating doctor decides that's appropriate. They've got to be stable. So they've got to have been on this medicine for quite a while and very stable and suitable otherwise as a patient. And that will be a risk assessment every doctor will take. 

MITSOPOULOS: The Pharmacy Guild said to me yesterday that 40 per cent of those medicines that will be on this list are already in short supply. I know that you dispute that, but they argue that patients could potentially miss out on medication because of this change. 

BUTLER: As I said yesterday, I advise people to take advice from the proper authorities about medicine shortages. That's certainly what I do. There are legislated bodies who are set up with experts who monitor the supply of medicines very carefully and where there are shortages, take action to remedy them. Now, your listeners will be very well aware, only too aware, that the pandemic really did impose some  big hits to our supply lines, not just Australia's, but across the world, there are some shortages of medicines that some of your listeners will be familiar with that don't just impact Australia. They’re impacting pretty much the rest of the world, and we're trying to address them.  

But on this question, you don't have to think about this for too long to realise I think that the claims made by the pharmacy lobby are just ridiculous. The number of tablets for cholesterol or for heart disease or diabetes that are dispensed between now and Christmas, or now and the end of next year is not going to change one bit because of this. There will be some changes to delivery schedules if you like, and we're going to make sure that those are put in place in a sensible way, but this is not going to impact the number of tablets dispensed at all, so it won’t impact supply in that sense at all. Also, I have been advised very clearly, of the 325 medicines, only 7 of them are experiencing supply problems, that's the advice I've got from the statutory authorities that are set up by law to monitor medicine supply. Now, there are some on the list where there are particular brands of the medicine that are experiencing shortages but those expert groups advised me there are other brands that people can take as an alternative. That's a very different question, so I think people should be wary about the pharmacy lobby seeking to sort of ramp up a scare campaign that suddenly we're going to run out of tablets because of this. It actually won't have us have a material impact at all on the number of tablets to get to spend. 

MITSOPOULOS: A couple of quick questions before we let you go and I know you had a pretty busy morning. What will happen to the Safety Net? Because if you're not paying as much for medication, it's going to take you longer to reach the threshold. So would those thresholds change? 

BUTLER: For pensioners in particular, and concession card holders, we slashed the Safety Net by 25% last year. So, cut that safety net, the maximum amount pensioners and concession card holders pay for all of their medicines needs across the year, we reduced that only several months ago by 25%. So now the maximum a pensioner will pay for all of their medicines needs, no matter how many medicines they take, across a given year is on average $5 per week, and we already made that reduction. We're not proposing to make another change. 

MITSOPOULOS: Just on another matter, a national class action from 500 people injured by the COVID-19 vaccine was filed in the New South Wales Federal Court yesterday. Now, these are people with quite debilitating injuries like a Perth woman, Tracey Bettridge, who still has pain and numbness post vaccine from a neurological disorder caused by an inflammation of the spinal cord. Now, she'd had two AstraZeneca shots and then had a Moderna shot. Do these people deserve compensation? 

BUTLER: The most important thing is that I deeply respect the ability of people to take legal action in this country and the other thing that's important, though, is that, particularly as the Federal Health Minister, I allow that legal action to take its proper course. You know, it is it is not appropriate for a Health Minister to comment on a matter that is before the courts. I completely respect the right of people to take matters before the courts. But it's also important that once that happens, I allow the court process to run its due course. 

MITSOPOULOS: Okay, the current COVID-19 compensation scheme though, that is administered by the Federal Government, only covers AstraZeneca related injuries. Do you need to expand that to cover other brands like Moderna? 

BUTLER: We’ll obviously continue to monitor the operation of that scheme set up by the former government, with our support, and I think it's been a very important part of the architecture, if you like, in our response to the pandemic, we'll keep that under review, but I don't have any particular decision to announce on that today. 

MITSOPOULOS: I'll leave it there and I do appreciate your time. Thank you. 

BUTLER: Thanks Nadia. 


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