Cancer is a leading burden of disease in Australia and affects many people of working age. In 2017, more than 134,000 Australians were estimated to be diagnosed with cancer, and of these, 40% were estimated to be of working age (25–64 years). [1]
Cancer understandably affects the ability to continue to earn an income, and a historical survey found that half (49%) of Australians aged 45–64 years with cancer were not in the labour force. In a more recent Australian study of cancer patients, 67% reported changes to their employment. Longer-term cancer survivors have an average 12% reduction in workforce participation compared to people without cancer. [2]
High Out Of Pocket Medical Costs
One in four cancer patients pay more than AUD 10,000 in out-of-pocket costs every 2-years and the cost of out of pocket expenses are rising over time [5]. On average, patients with cancer diagnosed in 2015 spent 70% more on out-of-pocket on direct medical expenses than those diagnosed in 2011. [6] [7]
Scientists continue to explore new potential treatments for Cancer and new drugs are regularly being developed and introduced to aid in treatment. But the drug development pathway can take 10–20 years. Once a drug is developed, it can then take time for it to be approved to be funded by the Pharmaceutical Benefits Scheme (PBS) in Australia.
- When a drug is covered by the PBS, The government pays most of the cost. The person having the drug pays a small amount called a co-payment,
- When a drug is not covered by the PBS, the person having it pays the whole cost. The cost of some drugs can be very high but may be the only hope for treatment.
Cancer medicines are some of the most expensive medicines on the PBS
Cancer-related scripts (2.6 million) supplied in 2013-14 represent only around 1% of all PBS scripts but made up just over 16% of total PBS funded medicine expenditure. [14]
Long delay between clinical trials and being listed on the PBS
The Australian health system provides us with a great degree of safety in accessing new medications. Independent decision-makers assess a new therapy to see that it works as well as its manufacturer claims it does, and is confident of the side-effect profile of each therapy. This takes time. When a drug successfully completes clinical trials, the pharmaceutical company that sponsors the drug must apply for regulatory approval from the TGA before marketing the drug. Historically, for cancer drugs, there has been a 14- to 31-month delay. A common reason is that pharmaceutical companies do not lodge the Pharmaceutical Benefits Advisory Committee (PBAC) submission at the same time as the TGA submission. This can be for a number of reasons, and these reasons are not always transparent to the public.
Options if a drug is not on the PBS ?
You may have to fund the entire cost of the drug on your own, without any PBS subsidies. It may also be possible to access new drugs at no cost or at a reduced cost through the pharmaceutical company that is marketing the drug.
If a drug is not yet approved in Australia, you may be able to travel overseas to join any new clinical trials. If this is the case, you will have to pay for your treatment, travel, accommodation and medical costs. The costs of Australians taking part in overseas trials can often exceed $100,000, plus the costs associated with travel and accommodation and lost income. You may be required to live overseas for the duration of the trial. There are several other options which are beyond the scope of this note. [12]
Example Of Non PBS Medicine Costs
From 1 Oct 2022, the PBS listing of pembrolizumab (Keytruda®) was expanded to treat patients with squamous cell carcinoma of the head and neck. Pembrolizumab is an immunotherapy which works by helping the immune system fight certain cancers. It is estimated that around 5,100 Australians will be diagnosed with head and neck cancer (including lip) each year. Without a PBS subsidy, up to that time, patients would pay more than $135,000 per course of treatment. [9]
Trauma Insurance Can Provide Financial Help
The cost of responding to some cancers can be very high. Trauma insurance is a type of policy that provides financial protection against the risk of facing these costs. A trauma insurance payment can help fund the cost of medicines not yet approved by the PBS, it can replace lost income for the person who is ill and lost income for the people who care for this person. And it can provide funds for many other expenses to be incurred, including costs associated with recuperation.
The information above is an extract of a longer article that can be found here.
The information in this article is general in nature. It does not allow for your own needs, goals and circumstances. Consider obtaining personal financial advice before buying trauma insurance. Always read the Product Disclosure Statement (PDS) before buying trauma insurance. The PDS will contain the definitions regarding when a claim would be paid.
Life insurance and Financial Advice services are provided by Experien Insurance Services Pty Ltd (EIS) ABN 99 128 678 937 and Experien Financial Services Pty Ltd (EFS) ABN 32 631 346 757. EIS and EFS are a Corporate Authorised Representative (No. 320626 and No. 1274354) Count Financial Limited ABN 19 001 974 625, AFSL 227232.
Written in November 2024.
Sources
- https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-018-5297-9
- https://pmc.ncbi.nlm.nih.gov/articles/PMC8964624/#:~:text=Results,CI%3D1.15%E2%80%931.21)
- https://www.health.gov.au/ministers/the-hon-mark-butler-mp/media/expanded-medicines-for-breast-cancer-and-leukaemia-on-the-pbs
- https://pmc.ncbi.nlm.nih.gov/articles/PMC9288471/#:~:text=On%20September%201%2C%202020%2C%20the,induction%20chemotherapy%20and%20who%20are
- https://pmc.ncbi.nlm.nih.gov/articles/PMC7967550/
- https://onlinelibrary.wiley.com/doi/10.5694/mja2.52367
- https://bmccancer.biomedcentral.com/articles/10.1186/s12885-021-08756-x
- https://www.canceraustralia.gov.au/
- https://www.health.gov.au/ministers/the-hon-mark-butler-mp/media/australians-have-access-to-more-affordable-and-lifechanging-medicines-on-pbs
- https://www.health.gov.au/ministers/the-hon-mark-butler-mp/media/expanded-pbs-listings-make-vital-treatments-more-affordable
- https://www.health.gov.au/ministers/the-hon-mark-butler-mp/media/new-cheaper-medicines-for-autoimmune-conditions-cancer-and-heart-disease
- Accessing non-PBS Funded Blood Cancer Drugs in Australia A discussion tool for you and your specialist. The Leukeamia Foundation. https://rcararecancers.blob.core.windows.net/assets/pages/LFPatientBooklets-Accessing-non-PBS-Funded-Blood-cancer-drugs-in-Australia.pdf
- https://www.aihw.gov.au/reports/medicines/medicines-in-the-health-system
- https://www.aph.gov.au/Parliamentary_Business/Committees/Senate/Community_Affairs/Cancer_Drugs/Report
- https://rcararecancers.blob.core.windows.net/assets/contentpage_htmlcontent/2024%20Rare%20Impact%20Report_FINAL.pdf
- https://rcararecancers.blob.core.windows.net/assets/contentpage_htmlcontent/RCA4997%20Canforum%202024%20Report_vF.pdf
