Beruflich Dokumente
Kultur Dokumente
Stephen Duckett
March 2013
Agenda
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Australias total spending on the Pharmaceutical
Benefits Scheme is increasing in real terms
6 Pensioner/
concession
General
0
1982-83 1987-88 1992-93 1997-98 2002-03 2007-08
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Although our prices were cheaper than UK and
Europe five years ago, theyre not now
Australias pharmaceutical price ranking against selected countries, 2007-2011
140%
120%
Ireland
Germany
100%
Sweden
UK
Belgium
80% Austria
France
60%
2007 2008 2009 2010 2011
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The market has two distinct submarkets
Patented drugs
Sole supplier arrangements
No patient choice
The (relevant) policy issues are whether the incremental benefits of
listing this drug is worth it and what should the subsidised price be?
Off-patent drugs
Potential for multiple suppliers
Low marginal cost of production
The (relevant) policy issue is what should the subsidised price be?
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Grattan analyses
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PBS prices are far higher than the comparators we
studied often by more than an order of magnitude
40
20
Average: 8.2
0
Drug-dose combinations
Note: chart represents the 58 identical doses for which the benchmark model was cheaper than the PBS. Only 39 drugs
where the PBS cost is more than twice that of the comparator are displayed (average is for all 58 doses).
Source: Grattan Institute analysis 7
One country, many prices
Estimated savings for generic and patented drugs
$ million
1800
1600
1400
Patented
1200
1000
800 Generic
600
400
200
0
Western Australia Unnamed state New Zealand
Source: Grattan Institute
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Our performance is worst when it matters most
Ex-manufacturer prices for identical drugs as multiples of NZ prices, by total cost (left) and volume (right), 2011-12
10 12
10
8
8
6
6
4
4
2
2
0 0
Drug-dose combinations (groups of 10) Drug-dose combinations (groups of 10)
High total cost Low total cost High volume Low volume
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The Atorvastatin story
If Australia paid the NZ price with current pharmacy mark-ups, the price
would plummet to $14.10, a savings to consumers of $22 per
prescription.
On current prescription volumes, and across the most commonly
prescribed forms of Atorvastatin, these higher prices (compared to NZ)
amount to excess costs to government of over $1.4 million every day
If patients in Perth could buy Atorvastatin at the same price as their local
public hospital, theyd save $19 per prescription
* At our reference date, October 2012 10
Lower prices would mean big savings for patients
Patient savings per pack (non-concessional patients), based on benchmark prices, selected doses, 2011-12
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Patient out-of-pocket savings
20
per box ($)
15
10
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The problems of the process
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The current price disclosure process
Minimum 12
Drug company collects price disclosure data
months
Drug company submits price disclosure data for the reporting period
Service provider (working for the Department) calculates average disclosed price
Scheduled reduction
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Current efforts to reduce prices dont go far enough
Current prices for drugs targeted for price disclosure
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Source: Grattan Institute analysis. Note: Amoxycillin + is amoxycillin with clavulanic acid.
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Current efforts to reduce prices dont go far enough
Price disclosure brings some drug prices down....
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Source: Grattan Institute analysis. Note: Amoxycillin + is amoxycillin with clavulanic acid.
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Current efforts to reduce prices dont go far enough
But benchmarking would save a lot more money
Source: Grattan Institute analysis. Note: Amoxycillin + is amoxycillin with clavulanic acid.
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The current flawed process - 1
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The current flawed process - 2
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Other countries require tough price drops with new
generics
Mandated generic price reductions, selected countries
Romania
Australia
Czech R
Slovakia
Hungary
Portugal
Belgium
Greece
Austria
Japan
Korea
0%
-20%
-40%
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Reform stage 1:
get the foundations right
Independent governance
Current A better
Indexed (rather than uncapped) approach approach
budget to live within
Political
Reverse the politics Clinical value decision
assessment about total
funds
All this can happen in 2013-14
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Next stages of reform
Stage 2
Stage 3
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Benchmarking against three jurisdictions yields up to $1.86
billion in savings
Generic pharmaceuticals make up the majority of savings Most savings come from New Zealands cheaper prices
$M Percentage of drugs from each jurisdiction
80%
1,400
70%
1,200
60%
1,000
50%
800
40%
600
30%
400 Patented
20%
200
10%
Generic
- 0%
Identical Substitutes New Zealand Unnamed Western PBS
pharmaceuticals State Australia
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Possible phase in
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Criticisms can we compare ourselves against other
jurisdictions?
The idea you can just pick and choose elements of other countries
systems and that automatically gives us a better, stronger systemis
incorrect
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Criticisms public hospitals are loss leaders?
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Criticisms sole supplier/tendering process would create
problems with access
New Zealand is a basket case when it comes to access to medicinesits the
last place health policymakers in this country should be looking to for ideas
Dr Brendan Shaw, CEO Medicines Australia
- Only relevant to patented drugs, not relevant to our proposed generic drug pricing reforms (vast
bulk of savings)
-However NZ does have lower access and a lag time with getting new drugs on market, but
prescription volumes for most commonly used drugs has increased while expenditure has been
nearly flat
$NZ millions (ex-GST and rebates) (2012)
Projected
3000
2000
Estimated expenditure
at 2000 subsidies
1000
Actual expenditure
0
2000 2005 2010 2015
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Criticisms the current system is working fine
Australian suppliers of generic medicines already sell their medicines at international
world best prices due to a very competitive generic medicines industry in
Australia[Grattans] concerns are unfounded as [price disclosure ensures that the
government benefits
- Kate Lynch, CEO Generic Medicines Industry Association
Similar statements from the Health Minister, Brisbane Times and Pharma in Focus
Romania
Australia
Czech R
Hungary
Slovakia
Portugal
Belgium
Greece
Austria
Japan
Korea
Ex-manufacturer price ($)
0%
10
-20%
5
-40%
0
-60%
Required reduction below originator price
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Criticisms - Choice
Its true that New Zealand does get a good price for
generic medicines, but they have a great deal less
choice for patients
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Would patients prefer a choice of 13 brands, or $22 saving?
Code & Medicinal Product Pack Max qty Max qty No. of Max Safety Max price to
Prescriber (Name, form & strength and pack size) packs units repeats DPMQ Net consumer
Available brands
APO-Atorvastatin
Atorvachol
Atorvastatin GH
Atorvastatin Pfizer
Atorvastatin SCP 40
Atorvastatin Sandoz
Chem mart Atorvastatin
Lipitor
Lorstat 40
STADA Atorvastatin
Terry White Chemists Atorvastatin
Torvastat 40
Trovas
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Other concerns lower income for retail
pharmacies
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Other concerns loss of research and
development in Australia
Types of pharmaceutical research and
development, Australia and USA, 2008
Lower prices = lower profits in Australia 60%
will hinder in-country R&D
Australia
Little evidence in-country prices drive
40%
R&D location
United States
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Ending Australias bad drug deal
stephen.duckett@grattan.edu.au
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