PwC Australia Partner John Cannings was diagnosed in 2014 with a rare lung cancer, ALK-rearranged (or ALK-positive) lung cancer. Less than 5% of patients with non-small cell lung cancer have tumors with a specific abnormality, a chromosomal rearrangement in a gene called ALK. John was one of them.
In Australia, the government subsidises the cost of medicines for most medical conditions under the Pharmaceutical Benefits Scheme (PBS). A new oral therapy has been developed as an alternative to intravenous chemotherapy for ALK-positive patients. It has statistically demonstrated significant improvements in progression-free survival rates and allows patients to take a pill twice a day, whenever and wherever they choose. But although this drug received regulatory approval in Australia in December 2013, not long before John’s diagnosis, it was not listed on the PBS for reimbursement, which could have significantly limited patient access to the drug.
John took the initiative to make his own private submission to the Pharmaceutical Benefits Advisory Committee (PBAC) to get the drug approved. One obstacle John faced was that the PBAC guidelines did not allow various non-economic benefits (such as productivity and efficiency benefits) to be considered. Working with PwC’s Health Economics team, he was able to demonstrate where the government in other social welfare areas had themselves relied upon and used the economic value of productivity impacts and efficiency benefits. The PwC analysis demonstrated an increase of approximately $17,000 AUD per annum per impacted individual, equaling a total benefit of $1.9 million AUD across the health system and workplace.
John’s submission was considered by PBAC at the November 2014 meeting at which time they approved the drug for reimbursement, nearly 3 years after it was registered, and it was listed on the PBS in July 2015. Patients can now be reimbursed for the cost with a small copay. The impact on patients from a financial perspective was enormous. Most importantly it allowed a large number of ALK sufferers for whom the drug was out of reach to gain immediate access, with the significant overall progression free rate and lifestyle benefits for them, their care-givers and their families.
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