This is a proposal to reduce Cabinet oversight of public spending, and it should be described that way. Raising or indexing the threshold means more listing decisions taken by a minister without collective consideration. PBS expenditure is large, growing, and difficult to reverse once a listing is made — medicines come off the schedule very rarely. Collective agreement before committing recurrent expenditure of that scale is a real fiscal control, and industry, which is the loudest voice for raising the threshold, has an obvious interest in fewer people being asked.

Delay is not always the government's doing. Recent academic work on strategic delay in Australian medicine reimbursement argues that sponsors themselves make timing and pricing choices that extend negotiations, because the alternative to agreeing a lower price now is holding out for a better one later. Attributing the whole of the gap between recommendation and listing to Cabinet would overstate it, and this database has no way to decompose it.

Ten months is a reported figure, not a published series. There is no official time series of Cabinet approval durations for PBS listings, which means the central number in this argument comes from advocacy rather than from the department. If the Commonwealth published listing timeframes by stage — PBAC outcome to price agreement, price agreement to approval, approval to listing — this proposal could be evaluated properly instead of argued about. That publication is arguably the more important ask.

And this reform does nothing for the medicines that need it most. A high-impact medicine for a large population is exactly the case where Cabinet consideration is most warranted. Indexing helps mid-sized listings cross back below the line; it leaves the largest and most contested where they are.