Canspeak's(Formally Cancervoices Australia)Involvementinthismattercommencedin

..._.....CanSpeak

thevoiceofthecancercommunity

Australia

29July2013

DepartmentofHealthandAgeing

ChemotherapyReview

MDP901

GPOBox9848

Canberra ACT2601

Attention-SubmissionsOfficer,

Reviewoffundingarrangementsforchemotherapyservices:

ThankyoufortheopportunitytorespondtothisReview.

CanSpeak's(formally CancerVoices Australia)involvementinthismattercommencedin

2009whenthegovernmentproposedchangestothesupplyofchemotherapydrugsthat wouldhavehadseriousimplicationsforpatientaccess,patientsafetyandpatientcosts. Ourconcernsthenandremainsotothisdateare-

1.PatientSafety

2. OperatorSafety

3. PublicSafetyand

4. QualityAssurance

ThesemattersareoutlinedinourPositionStatementattached whichwesubmitfor considerationoftheReviewPanel.

Shouldyouwishtodiscussthematterfurther,pleasecontactmeviaemail- telephone0295695447.

Yourssincerely

JohnStubbs

Executive Officer

CancerCommunityNetworkAustraliaLimited-ACN158710313

A:6/21GarnersAvenueMarrickvilleNSW2204Australia

E:M:+61407075525P:+61295696447

thevoiceofthecancercommunity

Australia

POSITIONSTATEMENT

CHEMOTHERAPYSUPPLYISSUE

April2013

BACKGROUND

In2008/2009 thegovernment proposedchangestothesupplyofchemotherapydrugsthatwould havehadseriousimplicationsforpatientaccess,patientsafetyandpatientcosts. Afteran extensivecampaignthatinvolvedalargenumberofstakeholdersrangingfromoncology pharmacists, medicaloncologistsandpatientgroups, thematterwassettled,orsowethought! Largesavingsweredelivered tothegovernment frombytheadoptionof:moreefficientuseof thedifferingvialsizesfordrugs;improvedauthorisation procedures;adoptionofthepatients drug chartratherthanprescriptionswrittenasthereimbursement basis;andagreement toprice disclosure inreturnforappropriate reimbursementforpreparation ofinfusions. Allofthese havebeenimplemented·exceptforthelatter. Savingssofartogovernment areoftheorderof

$230Mperannuminacancerdrugsbudgetof$1.48.

PreparationIssues

Thepreparation ofacancerdrugforinfusionisacomplexprocess: farmorecomplicated than, forexample,thepreparationofpenicillinforinfusion.

Theissuesare:

•PatientSafety.Patientshavetobeprotectedfrommicrobiologicalcontaminationtoa muchhigherdegreethanforotherinfusions,asmostpatientsonchemotherapy are immunecompromised.Theyalsohavetobeprotectedfromcrosscontamination with otherdrugsasmanyofthesedrugsproduceallergicresponses.

•OperatorSafety. Thesedrugsarecytotoxic-theykillcells. Theydoitby

interferingwiththeDNAreplication processesofcellssotheyarealsomutagenic, carcinogenic intheirownrightandteratogenic-theywillharmdeveloping embryo's. Itisabitlikeradiation,aspatientswegetlethaldosesfrommachinesinmassive bunkers. Staffhavetobeprotectedfromreceivingconstantlowdoses

•PublicSafety. Intheeventofanaccidentorspillthefacilitiesinwhichtheseare

preparedhavetobe abletobecontainedsothatthereisnoexposuretostafforpublic.

•QualityAssurance. Therehastobeprocessinplacetoensurethatpatientsgetthe rightdrug,intherightdose,attherighttime. Mistakesinthisareausuallyendup beinglethal. Considering thateachpatient'sdrugregimeislikelytoalteronadaily basisfollowing reviewbythemedicaloncologist,andinmanycasesthedrugshavea shortshelflifewhen madeup,wearedealingwithcomplexprocedures.

CancerCommunityNetworkAustraliaLimited-ACN158710313

A:22/57HerefordStreetGlebeNSW2037Australia

E::+61407075525P:+61295522406

Canpe

thevoiceofthecancercommunity

Aus·ratia

Sothesedrugsarepreparedin100%containment cabinets,housedinmultiplepressure controlledcleanrooms.Onedrugforonepatientishandledinthe cabinetatanyonetime and the cabinethastobecleanedbetweeneachdrugforeachpatient.Thefacilitiesinwhichthese drugsarepreparedhavetobeapprovedbytheTherapeuticDrugsAdministrationandregularly inspectedbytheTGA.ThisisnotsomethingthatcanbedoneinanyhospitalpharmacyorHigh StreetChemist.

Reimbursement

The·reimbursementfromthePharmaceuticalBenefitsScheme(PBS)isbasedonthe costof preparingadrugsuchaspenicillinforinfusion. Ittakesnoaccountofthehighlyspecialised processesandcostsofpreparingcancerdrugsforinfusion.

Untilrecentlytherewasaprocessofcrosssubsidyinplaceatthelocallevelthatmeantthat pharmacycostswerecovered. ThepricethePBSpaidforadrugwasnegotiatedwiththe companythatmarketedthedrug. Thispricewas thenfixed. Whenadrugcameoffpatentand themarketpricewaspaidlocally,thereimbursementwasstillbasedonthePBSagreedprice.

Soolderdrugs,offpatent,cross-subsidisedthecostofpreparing newerdrugsonpatent.

Thiswasdefinitelyanon-transparent,aninefficientwayofensuringaviabledeliveryofcancer drugstopatients.

PriceDisclosure

Partofthe changesimplementedinthelast decade waspricedisclosure. Thismeansthatwhen adrugcomesofpatentandgenericformsofthedrugbecomeavailable,thegovernmenteach

yearsetsapriceforadrug,basedontheaveragemarketprice ofthedrug. Thisisagoodthing supportedbyallparties. However,itdoesmeanthat,acancerdrug,off-patent,cannolonger crosssubsidisethe preparationofotherdrugs.

DeliveryofChemotherapyinAustralia

Nationallyprivatehospitals and standaloneoncologyclinicsprovide60%ofChemotherapy services. Theprivatesectorisresponsiblefor60%ofchemotherapyservicesnationally,but thereisconsiderablevariationacross statesreflectingthe'differingfundingmodelsused. Thereisahigherpercentageofcancerinfusionsourcedfromtheprivatesectorinruraland regional areasthaninmetropolitanareas.

CancerCommunityNetworkAustraliaLimited-ACN158710313

A:22/57HerefordStreetGlebeNSW2037Australia

E::+61407075525P:+61295522406

Chemotherapy Separations(sameday)byState

SourceAIHW,AustralianHosp1tal

..s2010-11,TablesS8.9and8.10

*SACancerServicesadvisethatpublichospitaldataisnotreflectedinAIHWdata .

# Source-SACancerServices·

THE 2012/2013CHEMOTHERAPYSUPPLYCAMPAIGN

Thisisnotaboutthepriceofdocetaxel,paclitaxel oranyotherdrug.Therearestill membersofthegovernment,mediaandsomeuninformed consumerswhobelievethatitis. It isaboutensuringaviableandtransparentsystemofdeliveryofacancerdrugfromthe pharmacytothepatientinawaythatdoesnotcompromise:

• PatientAccess

• PatientSafety

• PatientCost

Atpresentpharmaciessupplyingcancerdrugsforinfusionare losing about$100per infusion. Thatiseitherbeingpassedontohospitals,forthosethatoutsource their chemotherapysupply,orabsorbedintohospital budgetsforthosethatdotheirown. Itis affectingpubicandprivatehospitalsalike. OnaverageacrossAustralia,13,000infusions are preparedeachweek.

InNovember2012itwasthoughtthatsomehospitalswouldstopsupplyingchemotherapy.This hasnotyethappened. Whatishappening isthathospitalsarebeginning tonotoffertreatment for'chemotherapyintensive'cancersuchasleukaemiaandlymphoma-thatistheyare'cherry picking' whichdiseasetheycanaffordtotreat. Otherhospitalsarecuttingbackonancillary services-supportivecare-tocoverthecostofchemotherapy.

Asyetwehavenothadthesituation thatoccurredintheUS,where47patientsdiedasa·result ofcuttingcornersonthepreparationofinfusionsofcancerdrugs.

SoCanSpeakhasbeenworkingwithoverthirtyothergroupsofoncology pharmacists, oncologists,cancerfoundationsandcommunity groups, toensurethatthegovernmentaddresses the finalpointofthe2008/9agreement toensureaviablesystemofsupplyingchemotherapyto patients·inamanner thatensurecontinued access;highqualityassuranceandsafety,withno extracostimplicationsforpatients.

CancerCommunityNetworkAustraliaLimited-ACN158710313

A:22/57HerefordStreetGlebeNSW2037 Australia

E::+61407075525P:+61295522406

Progresssofar?

Negotiations havebeencontinuing overthepastfourmonths,verymuchinaspiritofgoodwill (although thatmayhavechangedrecently). OnWednesday20Marcha'crisisin chemotherapy'meetingwasheldinParliament House,Canberraattendedbyrepresentativesof theoverthirtyorganisations. Thiswasco-chairedbytheActingChairofCanSpeak. This meetingwasattendedbytheDeputySecretary oftheDepartment ofHealthandAgeing. Itwas addressed bySenatorXenaphon whohasinitiatedtheSenateEnquirythisweek,anda communiquefromthatmeetingwasbereleasedattheendofMarch. Unlike2008/9 the

minister hasrefusedtomeetwithrepresentatives ofthegroupandrecentactionsofheroffice havedestroyed muchofthegoodwill builtupoverthepastfourmonths.

Negotiationsarecontinuing,CanSpeakisprivytotheseanditishopedthattherewillbea successful outcometothebenefitofpeopleaffectedbycancer.

Thecostofrectifyingthissituationisoftheorderof$60Min achemotherapybudgetof$1.4B

andwithsavingsof$230Mperannumbeingdeliveredasaresultofagreementsmadein2009.

OurOrganisation

Weareanationalnetworkofconsumersandconsumerorganisationsrepresentingtheviewsand perspectivesofabroadrangeofpeopleandthecommunity affectedbycancer.Thisnetworkof peakmember organisations providesgreatercapacitytoworkindependently,andtogether,to influence policy,researchandhealthservicestoimproveoutcomesforpeopleaffectedby cancer.

Withmembersin allstatesofAustralia weareabletoaccessawiderangeofconsumersand accesstheirviewsonissuesofconcern.

CanSpeakpromotestheissuesofpeopleaffected bycanceratalocalandnationallevelby workingcollaboratively withhealthserviceorganisations, government,nongovernmentand charitable organisationsforbetteroutcomesandimprovedhealthservices.

25March2013

CancerCommunityNetworkAustraliaLimited-ACN158710313

A:22/57HerefordStreetGlebeNSW2037Australia

E::+61407075525P:+61 295522406