Down Under, Access Looks Different: What Australia Taught Me About Access and Affordability
Australia has some of the lowest drug prices in the developed world. It also has some of the longest waits for new medicines. As Washington debates Most Favored Nation (MFN) pricing, U.S. policy makers must know that this is no coincidence.
The Partnership to Fight Chronic Disease recently helped to convene a group of Australian patient advocates at Parliament House in Canberra. The message was clear and heartbreaking: lower prices do not guarantee access. Many medicines unavailable in Australia have been widely available elsewhere for years. PFCD Vice President of Policy & Advocacy Candace DeMatteis heard from advocates deeply concerned about the lack of access to innovation, the decline of stage 3 clinical trials in Australia, and worries that MFN pricing policy in the U.S. may lead to even fewer innovative medicines available in Australia.
As one advocate put it, “We’re a country the size of Texas. A company could easily decide not to launch here altogether.” In a recent survey, 84% of drug companies said Australia is becoming a lower priority for launching new medicines because of extremely low prices. If a country's prices don't make launching worthwhile, companies have no commercial reason to launch there and MFN in the U.S. further complicates that decision.
Crossing the globe for care
Three advocates shared stories about loved ones who left Australia to get treatment in the United States, as the necessary medications were not available in Australia. One had Alzheimer's disease, one had pancreatic cancer, and one had sickle cell disease. While these are three very different diseases, the patients all share the common problem of lacking access to the medicines they need.
Their stories reflect a wider problem:
Alzheimer's disease: In 2025, Australia's pharmaceutical advisory committee rejected donanemab, a drug that slows the progression of Alzheimer's. The committee said the risks outweighed the benefits, so patients who want it must pay thousands of dollars out of pocket to access it. Donanemab has been available in the U.S. since 2024.
Sickle cell disease: The U.S. approved Casgevy, a one-time gene-editing therapy, in December 2023. In clinical trials, roughly 94–97% of patients on Casgevy remained free from pain crises and hospitalizations for at least a year. As of 2025, the manufacturer had not announced plans to launch Casgevy in Australia, likely due to concerns that the country’s drug pricing policies would make a launch financially unviable, despite the therapy’s availability and reimbursement in more than nine other countries.
Pancreatic cancer: In 2026, trial results showed that daraxonrasib, a once-daily pill that targets gene mutations in cancerous cells, nearly doubled survival for patients with advanced pancreatic. The FDA opened expanded access to the drug for American patients in May 2026. In Australia, however, access runs through a clinical trial for patients with untreated metastatic disease, and only two patients have been able to access the drug to date. Additionally, these patients waited almost eight weeks from enrollment to starting the drug, a significant delay for such an aggressive disease.
Why the wait? A two-step system
Australia's Pharmaceutical Benefits Scheme (PBS) is the public insurance program that reimburses medicines so people can afford them. In Australia, access to a medication takes two separate approvals:
The medicine is approved as safe and effective.
The medicine is separately approved for PBS funding.
Step two is where patients get stuck.
The numbers are stark:
Even after a medicine is approved, patients wait an average of 466 days for PBS funding.
On average, Australians wait 3.6 years to access treatments already available overseas. Only 26% of new medicines available in comparable wealthy countries are funded in Australia.
A separate report found that only 25% of new medicines launched worldwide over the past decade have been funded in Australia, compared with 46% in the UK and 88% in the U.S.
When a medicine isn't on the PBS, patients often pay out of pocket. 43% of Australians prescribed a medicine not listed on the PBS face out-of-pocket costs.
The QALY problem
Before a medicine can be listed on the PBS, an advisory committee called the PBAC assesses its cost-effectiveness. This is usually reported as the extra cost for each quality-adjusted life year (QALY) gained.
A QALY combines the estimated improvement in a patient's length and quality of life into one number, which is then weighed against the treatment's cost. In plain terms, QALYs put a number on a year of life. That number is lower if you are older, have a disability, or live with a chronic illness.
This is discriminatory by design, so much so that use of the QALY is already banned from Medicare drug price negotiations under the Inflation Reduction Act. Yet in Australia, they remain central to deciding who gets treatment.
Delays are only part of the story. Australia's pricing system risks losing access to new medicines altogether.
What this means for the US: MFN warning signs
The message from the patient advocates in Australia was clear. Government price controls have a cost. While we debate the unfairness of paying more, they debate the unfairness of having access to less. The tradeoffs are real, significant, and provide proof that we cannot continue to enjoy U.S. innovation and rapid access to it with foreign reference pricing.
The U.S. currently has among the fastest access to new medicines in the world, with 88% of new launches funded compared with 25% in Australia. Importing other countries' price controls brings discrimination through the back door. It also risks importing their access and innovation problems longer term. People living with cancers, rare diseases, and other chronic illnesses, who depend on new and innovative therapies, would be the first to lose.
The bottom line
Behind every statistic from Australia is a patient who waited, paid out of pocket, or got on a plane to access the medications they need. Lower prices on paper mean little if the medicine never arrives. As U.S. policymakers debate MFN, Australia's experience is a warning about what we stand to lose.
Learn more about what MFN pricing could mean for the U.S.: fightchronicdiease.org/MFN.