I acknowledge the Ngunnawal and Ngambri peoples as the traditional owners of Canberra, and pay my respects to elders past, present and emerging.

Every time we do that, we should also acknowledge that the gap in outcomes for Aboriginal and Torres Strait Islanders remains an urgent national task for all of us. Im committed to working with industry, with all parts of our health care system, and most importantly with Indigenous Australians, to close that gap.

I also acknowledge your Chair Anna Lavelle and CEO Liz de Somer.

Well thanks for inviting me to close your policy symposium today.

Im conscious that Im the last person between you and drinks upstairs. Delaying your drinking may be good for your health but its unlikely to be good for mine, so Ill keep my remarks brief.

But I did want to join you to echo your message that medicines matter to patients, the community and the economy.

Thats why Labor created the PBS more than 70 years ago. To this day we include it on the list of Labors most significant achievements.

And its why we still fight, in Government and in Opposition, to protect and strengthen access to medicines for all Australians.

To be fair to the Minister, the PBS is also part of his four pillars.

But with respect, every time he talks about the pillars, Im struck that theyre about outputs, not outcomes.

Theyre about programs, not patients.

They describe what our system is, not what it should be.

So when we think about medicines, or about health in general, I think we need to shift from four pillars to three questions.

First, can Australians access affordable health care when and where they need it?

Second, do all Australians have a fair shot at a healthy life?

And third, are we reforming our health system to improve outcomes and meet the demands of the future?

I think the answer to each of those questions in turn is no not always, not yet.

Let me explain in relation to medicines.

First access.

The National Medicines Policy sets out our shared goal: timely access to medicines that Australians need, at a cost an individual and the community can afford.

Thats a good ambition.

But Medicines Australias latest COMPARE Report paints a bleak picture on whether we are achieving it.

It finds that the PBS subsidises less than half of the new medicines that are registered by the TGA.

That puts us 17th among 20 OECD nations. Seventeenth.

And when we do subsidise new medicines, were slow.

The report shows that the average time from TGA registration to PBS listing is 14 months.

Thats three months longer than the OECD average. Its almost four times worse than leaders like Japan, Germany and Great Britain.

And heres the strange thing: our registration and HTA processes are actually quite fast.

The UK Centre for Innovation in Regulatory Science conducted a separate study of eight advanced countries.

It found that the median time to HTA approval was quickest in Australia.

I know thats not always the case. I know it doesnt always feel like it.

But on average, the TGA and PBAC are fast by global standards.

Something happens afterwards. Between PBAC recommendation and PBS listing, our system slows down.

As we speak, there are almost 60 drugs that have been recommended by the PBAC but not yet listed on the PBS.

Ive spoken about that a lot in my first months in the portfolio.

Now let me be clear I dont highlight that for your benefit. Not because its important for industry.

I highlight it because its important for patients people rely on listings.

Those 60 outstanding recommendations mean thousands of patients are missing out on life-saving drugs.

Like Symdeko for cystic fibrosis, as well as Orkambi for two to five year olds with the condition.

Those drugs were recommended at the March meeting.

Cystic Fibrosis Australia says the time since then has been and I quote Seven months of lung damage, seven months of mental stress and strain, seven months of a blame game, and seven months of the best hopes and the worst fears exacerbated.

Thats whats at stake here.

And yet the PBS budget is flat or declining in real terms.

Behind the smoke and the mirrors, thats the reality.

When the Minister says that new PBS listings are a result of a strong budget or a strong eceonomy, hes not really telling the truth because the listings are coming out of a flatlining, not growing, PBS budget.

Thats come about because of the savings made by successive governments, from the Howard Government to the Rudd-Gillard Government to today.

In and of themselves, those savings were good things. They made the PBS sustainable and created the capacity to list new drugs that this Government has enjoyed.

But I do think we need to acknowledge and address the reality that a constrained budget is now contributing to delayed and denied listings.

As a start, I would hope that PBS savings would at least be reinvested in the PBS, to allow new listings.

We heard from the Minister last week that that may not be the case in relation to biosimilars and that should be a concern for everyone.

But we also need to acknowledge that even a PBS listing isnt a silver bullet for affordability.

The Bureau of Statistics tells us that 961,000 Australians a year delay or avoid filling prescriptions due to cost.

Thats why there was a bipartisan commitment at the election to reduce the PBS Safety Net thresholds.

And its why Ive urged the Government to use the 7th Community Pharmacy Agreement to address the affordability of PBS medicines for patients.

Which brings me to the second question whether all Australians have a fair shot at a healthy life.

Thats partly determined by their access to health care.

But its also determined by whether were addressing the social determinants of health.

Whether were doing enough to prevent disease in the first place.

And whether were tackling stubborn health inequalities for some of our fellow Australians.

Again, I think the answer to those questions is no.

We tend to think of your sector as providing treatments, and thats true.

But you also have an important role in prevention.

Last year, the Public Health Association nominated the top 10 public health achievements of the last 20 years.

Three of the 10 relied on vaccines or medicines.

The virtual elimination of measles, mumps, rubella and meningococcal C.

Falling rates of HPV and the cervical cancers it causes.

And the opportunity to end HIV transmission within this term of Parliament.

All of those rely on your life-saving work.

But as some of your members have highlighted, the long-term benefits of vaccines arent always understood as well as their short-term costs.

And of course, even where they are subsidised, the benefits of vaccines and medicines arent shared evenly.

A new study shows that kids who go to GPs in wealthy areas are more likely to get the flu shot.

Women are 70 per cent more likely to delay or avoid prescriptions due to cost.

And people who live in disadvantaged areas or have long-term health conditions are forced to skip medicines at around twice the rate.

Put simply, if youre poorer or sicker, you are less likely to get the essential medicines you deserve.

So weve got a way to go before we can claim that all Australians have a fair shot at health.

Which brings me to the third question are we reforming our health system to improve outcomes and meet the demands of the future?

I acknowledge theres a lot of work stemming from your Strategic Agreement with the Government.

But I think youd agree that were yet to see real outcomes.

For example by June next year, the Government is meant to reduce the average time from PBAC recommendation to PBS listing by two months.

June 2020 is just eight months away, but I dont see any evidence of that improvement in fact, quite the opposite.

And more broadly, I agree with Andrew Wilson that the National Medicines Policy has been undermined by piecemeal approaches to reform.

Thats why Labor committed before the election to a full and frank review of the National Medicines Policy.

We wanted the review to consider the entire medicines pipeline, from R&D to the quality use of medicines by consumers.

And we wanted it to consider the full range of challenges your sector faces.

Like the more competitive global environment for clinical trials.

And like the tension between old HTA processes and a new era of personalised medicine, including for rare diseases.

As Shadow Treasurer at the time, I didnt commit to a warts and all review of the National Medicines Policy lightly.

I knew it would probably recommend greater investment in the PBS.

I knew we would probably have to reverse the long term decline in the PBS budget.

But I also knew those things were important not for industry, but for patients.

I know the Government has also committed to a review of the National Medicines Policy.

Were yet to see details. But I hope the review will be as comprehensive and frank as Labor had committed.

To conclude medicines do matter to patients, the community and the economy.

And they should matter more to the Government.

We need to improve access, give all Australians a fair shot at health, and prepare our system for a future that is already upon us.

I look forward to working with Medicines Australia and its members to make that happen.

Now get to drinks. Ill see you there.