Has this Cowardly Lion found courage?

22 November 2024

The Wizard of Oz is a timeless tale made famous in the 1939 Judy Garland movie classic about a girl and her dog uprooted in a hurricane and landing in Oz where she sets out to find the famous Wizard, gathering three unique friends along the way.

The tale is essentially a hero’s quest, each of the four travellers looking for something unique. The Tin Woodman wants a heart, the Scarecrow wants a brain, the Cowardly Lion wants courage, and Dorothy wants to go home to Kansas.

In this local take on the tale, Australia’s pharmaceutical industry is the Cowardly Lion. The sector already has an enormous heart and no shortage of brains, but when it comes to courage it comes up short and, just like the Cowardly Lion, people are afraid to say publicly what they really think for fear of recriminations.

So it has been interesting to note the subtle mood shift in some sections of pharma in recent months, creating a sense that the Cone of Silence that sits over industry, the public charade that the Wizard of Aus (aka the PBS/NIP) is not all its cracked up to be, that the system is flawed and struggling is slowly creeping its way into the public narrative. It’s enough to ask, has Australian pharma finally found its courage?

Leading the way was Eli Lilly Australia and New Zealand General Manager Tori Brown, this feisty leader launching her company’s blockbuster GLP-1 Mounjaro on private script when the PBAC failed to recommend it last year.

Back again this month for a second turn at reimbursement, Brown did what only a fearless leader such as herself can do – she called out PBAC’s “procurement mindset” for impeding “equitable access to medicines that offer significant benefits to a significant number of Australians”.

Wow. Talk about courage in the face of danger. The risk of the PBAC knocking back Mounjaro a second time “because the patient pool is considered too large to allow for Government funding” is not lost on Brown, yet still she chose to call out a system that is indeed more focused on budget impact than longer term population gains.

MSD demonstrated its courage in comments on the multi-cancer funding proposal outcome released last month, and then again last week in stating that it had withdrawn its new innovative vaccine from PBAC consideration days before the committee met to consider it , knowing the newcomer would not be “appropriately valued”.

“MSD is withdrawing this submission due to concerns that the value of Capvaxive will not be appropriately recognised by the PBAC,” a spokesperson for the company said. “These concerns are based on repeated precedents of the PBAC not accepting value claims for vaccines on the basis of immunogenicity data. MSD believes the value of Capvaxive should be appropriately recognised by Australia’s HTA system.”

Double wow. MSD could have let the system play out and just accept a PBAC rejection, but instead it chose to step off the Yellow Brick Road, pull away the reimbursement mask, and call the system out for what it is.

Such honesty is almost unprecedented in Australian pharma. Companies usually decline to comment, or say their medicine ‘will be considered at a later date’, but here is both MSD and Lilly speaking out, openly and honestly. They aren’t hiding. They’re not toeing the industry line. They’re mad as hell and they’re not taking it anymore.

But wait, there’s more.

Sanofi demonstrated it is no soft touch when it comes to access, strategically working around PBAC and the National Immunisation Program in securing Federal support for State-based funding programs for its RSV biologic Beyfortus, while it also engineered an about-face from PBAC for its biologic Dupixent in atopic dermatitis by telling the committee if it held the line in insisting on a 50 per cent price cut, then it could watch Sanofi walk away from the listing, foregoing some $300 million a year in PBS income.

Now that’s a company prepared to put its money where its mouth is, to show some mettle, to demonstrate it means what it says. In short, Sanofi showed courage.

In another example, BMS Australia Senior Director, Access, Policy and Advocacy, Greg Cook, took to LinkedIn to call out the system, saying, “The introduction of PBAC intracycle meetings and increasing use of ‘out-of-session’ PBAC meetings across the last decade have been band-aids for the increasing workload. However, the system has now officially broken.”

And now, in an exclusive interview with MedNews published this week, Boehringer Ingelheim Managing Director Dirk Otto, who is preparing to leave Australia after 2.5 years to take on a global strategy and development role with BI, added his voice to the growing chorus, saying, “We have to become much more honest about our status in the world”.

“We compare ourselves with Switzerland and the UK and the US and Canada. That’s not our neighbourhood in pharma. Our neighbourhood is Chile and Portugal and Poland. Beautiful countries but maybe not examples to follow in terms of access,” he says, later adding, “We haven’t been a level one or first wave country in a while, and let’s just face it, let’s just admit it, we are not.”

Boldness is catching, this bravery movement fast gaining momentum as each person who speaks out, each company that speaks up, each media statement that calls out Australia’s health technology assessment system for failing to value innovative medicines and vaccines, that calls out the government for putting short-term budget considerations ahead of long-term health strategies, adding fuel to the fire, energy to the growing call for change.

The question now is, are you going to join the courage movement, or are you going to keep walking the Yellow Brick Road, living in hope PBAC’s Wizard of Aus will hand you a fair deal that genuinely leads to equitable access and better health outcomes for Australians?

Are you going to keep living in fear of bureaucratic or ministerial repercussions if you speak out, or are you going to tell the real story of the PBS, of delays to access, of lowest cost comparators, of decades-old vaccines funded on the NIP when newer options are turned away?

The bravery movement has started. The Courage Express is leaving the station. The choice now is jump on that train and join the movement, or forever stay in the wonderfully outdated Land of Aus.

©MedNews 2024