Navigating the PBAC: Strategies for Successful Reimbursement Applications

Authors: Ravi Visweswara, Executive Vice President, EVERSANA APAC; Robin Arnold, Executive Vice President, EVERSANA APAC; Amish Chaturvedi, Senior Director, Pricing and Market Access, EVERSANA APAC; Paul Lindsay, Senior Director, Pricing and Market Access, EVERSANA Australia

Crafting a reimbursement application to the Pharmaceutical Benefits Advisory Committee (PBAC) in Australia requires a comprehensive strategy for supporting the value of the medicine in a way that both the sponsor and the reimbursement committee will accept. The committee meticulously evaluates parameters including clinical data, cost-effectiveness, budget impact and consumer/physician input. A strategic approach ensures that these aspects are thoroughly addressed, increasing the likelihood of the PBAC recommending subsidy for the new medicine.   

EVERSANA’s team in Asia-Pacific has deep experience in framing and crafting strategies. Our approach begins with the end in mind, defining and explaining today’s unmet needs, supporting our description with clinical evidence demonstrating the new medicine’s improved efficacy and safety over existing treatments. This approach requires meticulous analysis and interpretation of clinical trials and real-world evidence, examining the new medicine’s unique benefits and their implications for patients. Importantly, we include ample support from clinician and patient inputs. Understanding and aligning on the gaps in today’s therapies and the potential improvement available to patients based on credible data and practitioner perspective creates a solid basis from which to dive into the economics. 

Given a need and potential solution, EVERSANA’s approach moves to address the new medicine’s cost-effectiveness. We do this by conducting rigorous country-specific pharmacoeconomic evaluations, with inputs validated by local clinicians and, where appropriate, patients.  With a clear and objective definition of the medicine’s economic value, the application is better prepared to meet the PBAC’s objective of optimizing healthcare expenditure while maximizing patient benefits. 

The third leg of a sound strategy is a clear and credible forecast of the financial implications of including the medicine in the Pharmaceutical Benefits Scheme (PBS) as well as proposed measures to mitigate any risks to the healthcare budget. By providing comprehensive budget impact analyses and identifying feasible funding solutions, the application demonstrates foresight and responsibility, ensuring real-world applicability and enhancing its credibility in the eyes of the PBAC. 

Experience shows that without a strategic approach, reimbursement applications may lack a clear frame, a coherent clinical and economic argument, and a rigorous evidentiary basis, reducing their persuasive power. Lack of strategic framing and perspective increases the likelihood of failing to communicate effectively in terms that are relevant and clear to the PBAC, which may, as a result, undervalue the medicine or outright reject it. This delays patient access to the new medicine and increases the costs required for the submission of a new application.  

EVERSANA’s most recent success with the PBAC is a testament to our approach. It is a striking achievement to succeed on the first submission, and we are grateful to our client and proud of our team for working together to achieve this important milestone.