Unease as PBS critic named to lead tech review

Labor has promised to review the controversial appointment of Dr Peter Boxall if it wins government.

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Controversy is brewing over the federal Department of Health’s announcement of a proposed reference committee for the Health Technology Assessment review.

The announcement came on 10 April, the same day that Prime Minister Scott Morrison set the election date, meaning any activities the committee will undertake will have to wait until the new government is installed.

However, it is the government’s proposed appointment of Dr Peter Boxall – a longstanding critic of the PBS – as chair of the committee, which is shaping up as a problem.

Opposition health spokesman Mark Butler said Labor did not accept the appointments made by outgoing Health Minister Greg Hunt. He said that if Labor was elected to government on 21 May it would consult with stakeholders over Dr Boxall’s and other committee members’ “proposed appointments”.

And an industry source who did not want to be named said Dr Boxall was the wrong choice to lead the review given his role as one of five commissioners that led the Abbott government’s National Commission of Audit. The audit was a response to the government’s inherited $123 billion in projected deficits from the previous Labor government.

Their report, delivered in 2014, recommended the introduction of new arrangements for funding the PBS, the establishment of an independent PBS authority which would oversee management of subsidised pharmaceuticals within the Australian health system, and increasing co-payments for all medicines under the PBS, including for concessional medicines that had been free.

The government committed to a review of the HTA system last year, with a clear goal to reduce the time it takes for Australians to access new health technologies. It is to be the system’s first major overhaul in 30 years.

On 10 April, the department posted the announcement on its PBS News website, saying the government had invited six candidates to serve on the review’s reference committee. They are: Dr Peter Boxall (independent chair), Ann Single (patient representative), Dr Dawn Casey (patient representative), Professor Andrew Wilson, (chair of the Pharmaceutical Benefits Advisory Committee), Professor Andrew Roberts (clinical/scientific representative), John Young (industry representative, retired senior Pfizer executive and former Medicines Australia chair) and Adriana Platona, (government nominee).

In a statement to The Medical Republic, a DoH spokesperson said the candidates had only been invited to serve on the committee and nothing had been finalised.

“The reference committee has not yet been established,” the spokesperson said.

“Formal offers of appointment (which would include any applicable remuneration) have not been made to the candidates.”

The spokesperson said the announcement was published before the government entered caretaker mode, a requirement of the election.

“Inviting candidates is one of the first steps towards establishing a committee,” they said.

The review’s terms of reference have not yet been established.

Under the terms of the terms of the review agreed to by the Commonwealth and Medicines Australia, the reference committee was to be appointed during the 2021-22 financial year, with the review to start in July.

“The Australian Government has agreed to support an independent review of Health Technology Assessment (HTA) current policy and methods used by the Pharmaceutical Benefits Advisory Committee (PBAC) to assess new medicines for listing on the Pharmaceutical Benefits Scheme (PBS), contemporary research, and relevant methodologies and purchasing practices used by comparable international jurisdictions,” the agreement states.

“The HTA review is a mutual acknowledgement by the Government and the medicines industry that medical technology is progressing rapidly, and a step-change is required to keep pace with advances in science as well as continuous evaluation and improvement to help ensure access as early as possible to the most effective medicines for all Australians.”

Medicines Australia CEO Elizabeth de Somer told TMR that they would be watching any developments around the committee in the next month very carefully.

“Within the constraints of the caretaker conventions, Medicines Australia regards the agreement of terms of reference for the HTA Review to be a major policy decision,” she said.

“As such, we will be vigilant to ensure that no decisions are made that would be against the interests of patients, our members, and other stakeholders.”

Ms de Somer said the biopharmaceuticals industry wanted the HTA Review to bring generational reform that benefited the whole health system, but especially the PBS, to produce better health outcomes for patients in the decades ahead.

“The HTA Review must build on the lessons learned from responding to the covid-19 pandemic,” she said. “Lives have been saved and quality of life for millions of Australians protected because of rapid access to vaccines.

“Faster access to new medicines, vaccines, and treatments is vital to protect Australia’s public health into the future. The HTA Review must be visionary and forward-thinking and based on solid investment in innovation, science and research.”