Access to high cost cancer medicines through the lens of an Australian Senate Inquiry - defining the 'goods' at stake.

In Australia, the government is the primary payer for cancer medicines, and is supported by the Pharmaceutical Benefits Advisory Committee, which makes recommendations about which medicines should be funded on the Pharmaceutical Benefits Scheme. There is an increasing perception that too many Australians are being denied timely access to cancer medicines—an issue that was recently explored in a Senate Inquiry into the Availability of New, Innovative, and Specialist Cancer Drugs in Australia. This is seen as a problem because cancer is considered a major burden on populations and health systems internationally, and the development of innovative cancer medicines is seen as a significant part of the solution to this problem. However new cancer medicines are often very expensive, leading in many cases to limited or delayed access. In this article, we present an analysis of the Senate Report resulting from the Inquiry, which illustrates that – in the Australian context – there are four main ‘goods’ that are prioritised by different stakeholders: 1) innovation; 2) compassion; 3) equity; and 4) sustainability. We observe that, with the exception of sustainability, all of these ‘goods’ put pressure on payers to provide access to cancer medicines more quickly and based on less rigorous evaluation processes. Speculating that our Australian observations can be generalised more broadly, we conclude the paper by exploring some of the consequences of giving in to such pressure, and suggest that there is a need to deconstruct the implicit values in calls for ‘enhanced access’ to cancer medicines so that more nuanced solutions to the exceedingly difficult problem of providing access to these high cost medicines can be found