Australia’s Health Technology Assessment (HTA) system uses comparative evaluation to determine the value of medicines against a relevant comparator, ideally reflecting real-world clinical practice. While Pharmaceutical Benefits Advisory Committee (PBAC) guidelines emphasise this principle, comparator selection has increasingly defaulted to the lowest cost comparator (LCC), even when it is not clinically appropriate. This shift has led to distorted economic evaluations, weakening the link between a medicine’s price and its true value. 

There is broad consensus that reform is urgently needed. A phased roadmap proposes eight actions over five years, including aligning guidelines with clinical practice, enabling earlier agreement on comparators, introducing flexible approaches for high-need medicines, and increasing investment in the Pharmaceutical Benefits Scheme (PBS). Longer-term reform includes a national life sciences strategy. These changes are essential to restore the integrity of HTA and ensure timely, equitable access to innovative medicines in Australia.

Key findings

• LCC use has become systemic, creating structural barriers to patient access. 
• These barriers influence reimbursement decisions, discourage investment and reduce Australia’s attractiveness as a launch market for innovative medicines. 
• The impacts are already visible: patients experience poorer health and financial outcomes, clinicians face constraints in delivering optimal care and pressures on the healthcare system are increasing. 
• Clinical trial activity is also at risk, limiting access to emerging therapies.