Tuesday, 17 June 2008
National Health Amendment (Pharmaceutical Benefits Scheme) Bill 2008
Debate resumed from 16 June, on motion by Senator Faulkner:
That this bill be now read a second time.
I am pleased to rise to speak on the National Health Amendment (Pharmaceutical Benefits Scheme) Bill 2008. This bill makes minor amendments to the National Health Act 1953 which are desirable either to extend the operation of the PBS in certain circumstances or to remove some anomalies. For a relatively young country, Australia has a proud record on schemes which allow equitable public access to medicines and other pharmaceutical items. My colleague the shadow minister for health in the other place, Mr Hockey, detailed some of the history of the PBS in his speech in the second reading debate. I will not repeat that, but it is certainly worth while placing some of it on the record of the Senate.
The original scheme to provide access to pharmaceuticals was the Repatriation Pharmaceutical Benefits Scheme established in 1919, in the wake of the Great War, to provide free pharmaceuticals to ex-servicemen and women. At that time, the Hughes Nationalist government brokered agreements with the major drug houses to extend the facility not only to World War I veterans but also to those from the Boer War. The Curtin government tried to introduce a limited free scheme in 1944 but was opposed by the Australian branch of the British Medical Association, the precursor of the AMA, and the legislation was struck down by the High Court. A pharmaceutical benefits regime was successfully established during the term of the Chifley government but it was essentially limited to remote communities. It is a matter of pride to me as a Liberal that the Pharmaceutical Benefits Advisory Committee, which underpins the operation of today’s contemporary PBS, was established by the Menzies government in 1953.
Particular mention in this debate must be made of the contribution made in this regard by Sir Earle Page. At the time Page was the Country Party leader and the Minister for Health, having served briefly as Prime Minister during the dark days of World War II. The current Deputy Prime Minister, Ms Gillard, rightly paid tribute to Sir Earle Page as the father of the PBS in an Evatt Foundation lecture in 2006. As a young surgeon, Page had contracted an arm infection while conducting a postmortem. The infection proved almost fatal. In 1942, when Page was Australian minister resident in London attending Churchill’s war cabinet, he succumbed to pneumonia and again was lucky to survive. So in 1953 Australia was fortunate to have as the Minister for Health someone who carried great weight in the cabinet as Country Party leader, who was a surgeon by profession but who also had personal experience in the dangers of infection and the benefits of antibiotics. As a doctor himself, Page was also able to act as a peacemaker with the BMA after their vehement fights with the previous Labor government. With such a happy line-up of the planets, Page established far-reaching public policy. Over five years from 1950, Page successfully piloted through parliament legislation to provide free essential drugs to the community, to maintain free medical services for the poor, to support private health insurance funds and to increase federal government grants to hospitals. All of these have endured through bipartisan support over the last 60 years, though I must say that the Rudd government’s recent budget decisions regarding a Medicare surcharge have severely undermined one part of our health system.
The bill before the Senate today extends pharmaceutical benefits to government officers working outside Australia and their accompanying spouses and dependent children. It also extends pharmaceutical benefits to couples, whether married or in a de facto relationship, who live apart owing to illness or infirmity. Couples in such circumstances will be able to continue to be considered as a family for the purposes of their entitlement to safety net concession and pharmaceutical benefit entitlement cards. I commend the government for making both of these changes. They certainly have the opposition’s wholehearted support.
The bill also widens the criteria used to determine that brands of pharmaceutical items may be co-marketed. The Bills Digest questions what effect this change will have on the industry, and I would be interested to know the answer to that query. There are areas of health policy on which the government and the opposition profoundly disagree. One of those is the constant spectre of the socialisation of medicine, which seems to be the concern of many in the medical profession, through the ill-considered development of GP superclinics. Those who remember the Whitlam government’s ill-fated community health centres will know exactly what I mean. However, with regard to fair and reasonable access to essential and life-saving medicines, there has never been any disagreement. Consistent with the bipartisan nature of the support for the PBS, on behalf of the opposition I commend the bill to the Senate.
I do not wish to make a long speech but just acknowledge the Australian Democrats’ support of the National Health Amendment (Pharmaceutical Benefits Scheme) Bill 2008. It is largely technical and non-controversial and we welcome the improved access to the PBS safety net for those who are separated by ill-health or service overseas working for government. I must respond to Senator Colbeck’s remarks about the ‘ill-fated community health centres’, in referring to the socialisation of health in this country, and tell him that in Victoria they are not ill-fated at all; they are thriving and are a very important part of our medical system.
I indicate that I have circulated an amendment which would fix the discrimination against same-sex couples that is inherent in the PBS safety net and which, as we all know, exists in so many other bills. But I will not move that amendment because I have an undertaking from government that this matter of discrimination will be sorted out in the spring sittings of parliament.
I also take this opportunity to condemn the opposition for effectively delaying bills which will fix same-sex discrimination in Commonwealth laws, until 2009. It is unwarranted. HREOC produced a very substantial report which demonstrated the reasons why we need to fix these problems. There is no good reason, in my view, for the matter to be further delayed. As senators in this chamber will recall, the Democrats have put our standard amendment, as we call it, to many bills for many years in this place, and it is very disappointing that we have to leave the Senate with this bit of business not yet done. I would ask the minister with the carriage of this legislation to just confirm for the public record that this amendment will be dealt with in good time, so there will be no need for me to move the amendment, which I have circulated in the chamber.
The Pharmaceutical Benefits Scheme, the PBS, is regarded as one of the best systems of its kind in the world. It provides affordable access to high-quality medicines for all Australians by subsidising the cost of PBS medicines and delivering them through local pharmacies and hospitals in our communities. The PBS safety net insures that families and individuals who require large amounts of medicines are protected from high cumulative costs. The National Health Amendment (Pharmaceutical Benefits Scheme) Bill 2008 contains amendments to the National Health Act 1953 which, although unrelated, will help to ensure that the PBS remains current and operates effectively for all Australians, whether as PBS users, suppliers or the medicines industry.
One of the amendments improves access to the PBS safety net. This will mean that couples living apart, due to illness or infirmity, will be able to use the safety net jointly. These couples will be able to combine PBS co-payment contributions towards the same safety net threshold. Both persons will be able to be included in the same safety net card and will have access to safety net benefits once the threshold is reached. In effect, the PBS payments required for both members of a couple to reach the safety net will be the equivalent of one safety net threshold, not two. This has the potential to reduce the out-of-pocket costs for PBS medicines for such couples by an amount equal to the relevant safety net threshold. PBS medicines required by either person can then be obtained at the reduced safety net rate for the remainder of the calendar year. This amendment strengthens the ability of the PBS safety net to deliver real benefits in savings to the people who need them. It recognises that when couple members need to live apart, for reasons of ill-health, frailty or dependent care, they do not cease to be part of a family. It provides continuity for joint access to safety net entitlements for these couples, despite their living circumstances having changed permanently. It will improve the affordability of PBS medicines for these people at a time in their lives when they may be most in need of PBS benefits.
The bill also amends the act to extend access to the PBS for government officers working outside Australia. Current PBS eligibility, supply and export restrictions prevent pharmaceutical benefits being provided to government officers when working overseas, despite eligibility for the PBS in Australia. However, accessing medicines outside Australia can be difficult and uncertain. The changes will allow pharmacists to dispense PBS prescriptions for medicines required by these officers, accompanying spouses and dependent children and for those medicines to be sent outside Australia in quantities required for their personal use. This will provide access for these Australians to quality, affordable medicines and PBS safety net entitlements.
The amendment to the criteria for determining co-marketed brands will ensure that the legislation operates as was originally intended. The amendment will allow co-marketed brands to remain co-marketed in certain circumstances and to continue to have the co-marketing pricing benefits, even if they are brands of more than one pharmaceutical item. In addition, the amendments provide that the minister may, by legislative instrument, determine that co-marketed brands cease to be co-marketed. The ministerial determination will have precedence over the regulations prescribing co-marketed brands. This is an important amendment as it facilitates timely and efficient administration of the PBS co-marketing arrangements. In response to Senator Colbeck’s question as to how the co-marketing provisions affect industry, I am advised, Senator, that this will be positive for industry, because co-marketed items are protected from statutory price reductions. If there is further information that you would like on that, I am happy to provide it.
This bill also contains minor and technical amendments which change the way that two definitions are referred to in the act and removes the requirement for gazettal of certain ministerial determinations. The relevant determinations will be legislative instruments for the purposes of the Legislative Instruments Act 2003. In response to the question posed by you, Senator Allison, I acknowledge that you have indicated that you will withdraw the amendment that your party has consistently applied to lots of legislation, including PBS legislation. I want to put on the record that the Labor Party is committed to a consistent and comprehensive response to the broad suite of legislation that does not recognise same-sex relationships. This will be part of the audit that we do of legislation to ensure that same-sex couples are considered. There will then be a full response, hopefully, in a short period of time—but not short enough, unfortunately, for the Democrats to be able to vote for it. We acknowledge the Democrats’ persistence, throughout the time they have been in this chamber, in attempting to ensure that same-sex couples are not discriminated against—a view that is shared by the Labor Party.
Finally, I want to thank Senator Colbeck and Senator Allison for their contributions to the debate and for the support of this bill. The changes in the bills strengthen the PBS and improve access to PBS entitlements. The government will continue to monitor the PBS to ensure that it is operating as intended and to ensure that access to necessary medicines is available when needed by those Australians eligible to receive them. I commend the bill to the Senate.
Question agreed to.
Bill read a second time.