Private  Health  Insurance  &  Pharmaceuticals

29  July  2015

Tim  James,  CEO  Medicines  Australia

Agenda• Overview  pharmaceutical  sector  in  Australia• Developments  in  innovative  medicines• PBS:  expenditure  &  funding  -­ challenges• Bridging  the  gap  -­ opportunities• Role  for  PHI• Discussion

Medicines  Australia  Members

Mylan  EPD

Australia’s  innovative  pharmaceutical  industry

• More  than 50  originator  companies• Over  400 local  biotechnology  companies• Employs  over  14,200 Australians  • One  of  Australia’s  largest  manufactured  exports  $2.9  billion   in  2014  

• $1  billion  on  R&D  annually• 743 active  clinical  trials  in  18 therapeutic  areas  conducted  in  Australia

Developments  in  new  medicines

• Over  12,300  products  from  the  major  companies  in  development  

• Increase  of  8.8%  since  last  year    • The  5  largest  Medicines  Australia  members  have  over  1,000  products  in  development    

• New  classes  of  products,  targeted  biological  medicines

Developments  in  new  medicines  

Source:   The  Global   Use  of  Medicines:   Outlook   Through   2016Report  by  the   IMS  Institute   for  Healthcare   Informaticshttps://www.imshealth.com/depl oyedfiles/ims/Global/Content/Insi ghts /IMS%20Institute%20for%20Healthcare%20Informatics/Gl obal%20Use%20of%20Meds%202011/Medicines_Outl ook_Through_2016_Report.pdf

• 32-­37  innovative  products  expected  to  be  launched  every  year

• Includes  treatments  for  Alzheimer's,  autoimmune  diseases  and  various  types  of  cancer

Australia  ranks  18th out  of  20  OECD  countries  in  access

PBS  Expenditure  &  Funding  

Source:  “Final  Budget  Outcomes    2007/8-­‐2013/14

PBS  remains  sustainableDownward  revision  of  PBS  expenditure  estimates

Source:  “2014  Budget  PBS  Scorecard”,  Medicines  Partnership  of  Australia,  2  June  2014.  http://medicinespartnership.com.au/category/pbs-­scorecards/  

Government  dominant  funder  of  pharmaceuticals  -­ shifting

Source:  AIHW  2012-­‐13  2011-­‐12,  2010-­‐11,  2009-­‐10,  2008-­‐09  Health  expenditure  database,  prescribed  medication  expenditure  data

Private  funding  of  pharmaceuticals

Source:  OECD  Health  Statistics  2013,  http://dx.doi.org/10.1787/health-­data-­enExpenditure  on  pharmaceuticals  per  capita  and  as  a  share  of  GDP,  2011  (or  nearest  year)  

• In  Canada  and  the  US  PHI  plays  a  important  role  in  providing  primary  health  coverage

Bridging  the  PBS  gap  and  ensuring  timely  access  

• Increasing  incidence  of  medicines  poorly  or  not  at  all  covered  by  PBS

• Consumers  and  industry  looking  to  more  flexible  models  and  solutions  

• Oncology  medicines    • Hep  C  medicines  

Opportunities  for  PHI

• Look  beyond  PBS  • Active  consideration  in  sector  • Leveraging  overseas  experience• Seeking  collaboration  with  government• Link  to  value  of  medicines  • Societal  benefits

Challenges  for  PHI

• Political• Cultural• Funding• Legal  /  Regulatory  constraints  

Actions  and  Next  Steps

• Industry  project  • Focus  on  particular  treatments  /  areas• Not  limiting  to  PHI• Stakeholder  engagement• Seeking  feedback  and  input  

Discussion