The power of vested interests and why drugs cost so much in Australia. John Menadue

Jan 17, 2014

Why does the widely used cholesterol reducing drug Atorvastatin cost $A19 in Australia and $A2 for the same package in NZ? Why does the widely used cancer drug Anastrozole cost $A92 in Australia when the equivalent drug in the UK costs $A3.30. The answer is the political power of Medicines Australia and how it twists the arm of governments.

In a blog on January 7, I drew attention to the political power of vested interests to undermine the public interest and good policy development in Australia. I referred  particularly to the miners and their role in destroying the super profits tax, the polluters’ opposition to the carbon tax, the hotel and liquor industry which is responsible for violence on our streets and poor health in the community, and the gambling industry particularly Clubs Australia, that successfully opposed proposals to shield problem gamblers. Just consider how James Packer has been able, so easily, to use his political power to avoid any public process in obtaining a licence for his “high-rollers” casino in Sydney.

What makes these vested interests so dangerous is their power to persuade or threaten politicians. The media is ill-equipped to contest their power. In some cases, The Australian and the Australian Financial Review newspapers become outlets for these vested interests.

Medicines Australia (MA) is a classic case. It represents the pharmaceutical industry in Australia. Its members supply 86% of the medicines that are available in Australia under the Pharmaceuticals Benefits Scheme. (PBS)

The Grattan Institute has pointed out how, with the cooperation of pliant governments, MA has been able to exploit Australian consumers and taxpayers. The facts are quite clear. For March last year, the Grattan Institute reported as follows:

  • For Atorvastatin, the cholesterol reducing drug, the PBS in Australia paid more than $51 for a box of 30 tablets. NZ paid $A5.80 for a box of 90 tablets.
  • Grattan also looked at the ‘top 73 doses that are prescribed most often in Australia’. It found that Australian wholesale prices were eight times higher than NZ’s. For identical drugs, NZ prices were six times cheaper than in Australia.
  • Grattan also compared prices in some public hospitals in Australia who buy drugs outside the PBS. It found that on average these hospitals obtained drugs eight times lower than the prices under the PBS.

Those comparisons where for March last year. In December last year, under what is called ‘price disclosure’ arrangements, prices were reduced.  However, the Grattan Institute found that even with these reductions, Australia was still paying sixteen times more than the UK and NZ for seven key drugs. For example the cost of Atorvastatin dropped from $A30 to $A19 for a pack in Australia. The same pack sold for the equivalent of $A2.84 in UK and $A2.01 in NZ. For Anastrozole, the cancer drug, the wholesale price in Australia is $A92 and in the UK $A3.30.

How can these outrageous differences occur?

Before a drug can be registered on the PBS it has to be cleared by the Therapeutic Goods Administration for safety and efficacy. Then it is assessed by the Pharmaceutical Benefits Advisory Committee for cost effectiveness and clinical benefit. The Pharmaceutical Benefits Pricing Authority (the Pricing Authority) then determines the maximum price that can be charged and how much the Government will pay manufactures or importers under the PBS.

The Pricing Authority, a non statutory body is set up by the Minister and is within the Department of Health and Aging. The Authority includes, amongst its six members, two representatives of drug companies. That is extraordinary-building vested interests into the price setting process. They should be excluded completely.  The whole process is opaque, and political. It is ready made for manipulation by vested interests.

In NZ, politicians decide how much is spent by the government on drugs and an independent and professional expert panel sets prices. In Australia we have the process the other way round. Our politicians should determine the budget for drugs at the beginning of the process and then get out of the way and let market competition work and leave final price decisions to independent experts.

The vested interests get their fingers all over the price of drugs on the PBS. In NZ they are excluded from the process.

Grattan Institute estimates that Australia’s wholesale prices for identical drugs are now six times the prices paid in NZ. In some cases they are as much as twenty times higher. Grattan Institute estimates a saving of almost $A2 billion p.a. if we paid the same price as in other relevant jurisdictions.

The Chief Executive of MA is Brendan Shaw. He was formerly a staffer for Dr Craig Emmerson. It is typical of the pedigree of vested-interests and their political lobby that they choose persons well-known and influential in the political corridors of power in Canberra. .

In response to Grattan’s findings, Brendan Shaw in the Australian Financial Review made an irrelevant point that because of budget restraints in NZ, fewer new medicines were available in that country. He avoided completely the issue of price comparisons. I would rather rely on the professional advice of independent experts on what drugs should be on the PBS and the prices we pay.

When will we seriously tackle the exploitation of the public that Medicines Australia inflicts upon us?

The Department of Health and Ageing should be spending its time developing and implementing improved health policies. Instead it spends its energy and time placating the powerful rent-seeking vested interests in our health services – Medicines Australia, the AMA, the Pharmaceutical Guild of Australia and the Private Health Insurance companies.

The Rudd and Gillard Governments did little to curb the abuse of political power by these groups in the health field. In fact they made the situation worse. The Rudd Government appointed a senior executive of BUPA, the second largest private health insurance firm in Australia, to head the National Health and Hospital Reform Commission enquiry.

Ross Garnaut described the power of vested interests in Australia as a ‘diabolical problem’.  He is right. If the Commission of Audit wants to save some real money and curb rent seeking it could start with vested interests like Medicines Australia.

Governments and particularly conservative ones extol the virtues of markets. But all too often this is a diversion, designed to advantage corporations, like the members of Medicines Australia, rather than letting markets work and promote competition and lower prices.

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