first complete review of the system in three decades<\/a> was handed to the federal government in 2024, making several recommendations aimed at streamlining processes so people could access subsidised medicines earlier.<\/p>\nAn advisory group is guiding the government’s response to the so-called Health Technology Assessment (HTA) review, but Ms de Somer said the latest stalemate over Mounjaro highlighted the need for more urgent action.<\/p>\n
“The government has recognised that there’s an issue. Stakeholders, patients, patient groups, and their families and communities have recognised there’s a problem here,” she said.<\/p>\n
“It’s now a time to act, and we’re ready and waiting.”<\/p>\n
Patients forced to ration Mounjaro due to expense<\/p>\n
Ingrid Baas-Becking is a double diabetic, meaning she has type 1 and type 2 diabetes, and has to pay almost $700 every two months for 15 milligrams of Mounjaro.<\/p>\n
This puts immense financial strain on the 74-year-old who relies on the pension.<\/p>\n
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Ingrid Baas-Becking said her health had improved immensely since starting Mounjaro. (Supplied: Ingrid Baas-Becking)<\/p>\n
“I’m doing without other things to afford the Mounjaro \u2026 I can’t do anything other than buy the Mounjaro.”<\/p>\n
Mounjaro is a unique type of GLP-1 drug because it also mimics the GIP hormone to improve insulin sensitivity and decrease appetite.<\/p>\n
Since starting Mounjaro this year Ms Baas-Becking has seen major improvements to her health, which she did not experience when she tried other GLP-1 drugs.<\/p>\n
“I’m losing weight for the first time in my life and I’m using about 50 per cent less insulin.”<\/p>\n
But Ms Baas-Becking said she was rationing the drug because she could not afford a higher dose.<\/p>\n
“I’m counting the clicks [of the injectable pen]. I’m taking half the dose because if I used the full dose I would be buying it every month, not every two months.”<\/p>\n
She said it was, “disappointing” Mounjaro still wasn’t going to be added to the PBS and the announcement “lowered the reputation” of Eli Lilly in her opinion.<\/p>\n
Keeping PBS prices low comes with trade-offs: health economist<\/p>\n
Once the PBAC recommends a medication be listed on the PBS, the government negotiates with the pharmaceutical company to strike a commercial agreement that aims to protect taxpayers by mitigating risks, like uncertainty around the overall cost to the PBS.<\/p>\n
Under one type of agreement, if the drug is prescribed to more people than anticipated, the pharmaceutical company will share the additional cost with the government.<\/p>\n
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Mounjaro, a tirzepatide injection drug, is used for treating type 2 diabetes. (Reuters:\u00a0George Frey)<\/p>\n
Manny Simons, general manager of Lilly Australia and New Zealand, said this presented a “disproportionate financial risk to Lilly”.<\/p>\n
“Our decision was driven by the simple reality that the price conditions proposed by the Australian government are unrealistic and unviable,” Mr Simons said.<\/p>\n
Health economist at the University of Melbourne’s Centre for Health Policy, Philip Clarke, said it was unclear whether Eli Lilly was bluffing just to get a better deal.<\/p>\n
“It is hard to judge the financial costs and risk to Eli Lilly as the prices the government actually pays for new drugs are often not disclosed,” he said.<\/p>\n
Professor Clarke said the government’s commitment to keeping the prices of PBS medication low can could with trade-offs and meant not every drug would be listed, especially when there were alternatives.<\/p>\n
“If you go into a shop and want to buy every car you’re not going to get a good deal,” he said.<\/p>\n
“It’s important to recognise that in the current constrained budget environment, the more taxpayers spend on one drug, like Mounjaro, often the less funding is available for other medicines.”<\/p>\n
Health Minister Mark Butler said he had asked his department for advice about the negotiations with Eli Lilly.<\/p>\n
“There are often very robust price negotiations between big multinational drug companies and the federal government, the officials that we ask to do that work for us,” Mr Butler said on Sunday.<\/p>\n
“That tension really and that price negotiation is a very big reason why we have such a successful and sustainable Pharmaceutical Benefits Scheme.”<\/p>\n
Semaglutide, which is sold under the brand name Ozempic, is already listed on the PBS for people with type 2 diabetes and Wegovy, with the same active ingredient, has been recommended for PBS listing.<\/p>\n
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