Ministerial Discretion may be the only solution to ensure MATOD medicine choice

In November 2021 AIVL shared news of the National Health Amendment (Enhancing the Pharmaceutical Benefits Scheme [PBS]) Bill 2021, where we raised our concerns regarding the statutory price reduction of slow-release buprenorphine and the potential impact this may have on people who choose this form of Medically Assisted Treatment for Opioid Dependence (‘MATOD’, see National Health Amendment Bill 2021: More Transparency And Community Consultation Needed). Since AIVL’s last publication on the matter the PBS Bill has had its second and third readings, by 2 December it was passed in both Houses, and it was given Assent on 13 December 2021.

On its face a ‘statutory price reduction’ sounds like a good thing and, in many ways, it is, but this is not a cost-saving for the person who receives the prescription. Rather it is a structured process where the cost to the Government in acquiring medicines is reduced over time and increasingly once a medicine is 5+ years old. While the chemical structure of buprenorphine is more than 15 years old, the slow-release formulation is less than 4 years old. The innovation of this slow-release formulation is that people who choose this option don’t have the burden of a daily visit to their pharmacy for dosing, which is a quality-of-life enhancing benefit for many. The potential impact we are concerned about is that the price reduction, as applied to these new formulations of the older chemical structure, may make the products unviable in the Australian market. Therefore, limiting the MATOD medicine options available here would be devastating for the 1000s of people who are currently stable on bupe.

There may be other impacts worthy of further inquiry too, like whether this treatment being withdrawn from the market will have an impact on drug trends, overdose rates, or the incidence of other drug-related harm? Further, the slow-release formulation is a preferred option in some custodial settings in some jurisdictions and ensuring treatment continuity is critical for all people using MATOD and especially for people transitioning back into the community.

AIVL will continue to monitor this situation and recommends that if there are any adverse impacts for people who use MATOD, this must be researched and supported by advocacy from our network. The PBS Bill does still allow for ministerial discretion, and the Health Minister can intervene regarding the application of the legislative price reduction if it is demonstrated to have unintended consequences.

Here is a community position by The International Network of People who Use Drugs (INPUD) on  Extended-Release Opioid Agonist Products. 

Media release by Steph Tzanetis (Principal Project Officer,  AIVL)