Balancing Access and Value in Multi-Indication Medicines: Implications of PD-(L)1 Broad Listings in Australia

Multi-indication medicines challenge health technology assessment processes as health technology assessment relies on repeated indication-based assessments to determine cost-effective pricing and reimbursement. The reimbursement of programmed death-(ligand) 1 inhibitors is an international example of this. In 2025, Australia's Pharmaceutical Benefits Advisory Committee adopted a novel broad cancer listing on the Pharmaceutical Benefits Schedule for nivolumab, ipilimumab and pembrolizumab. This agreement consolidates all advanced and metastatic cancer indications under a single broad listing per medicine, using a single weighted-average price and utilisation-based rebate caps. This article analyses the economic, policy and clinical practice implications of such an agreement. The broad listing agreement features several characteristics identified in the literature as desirable for a multi-indication reimbursement framework, including facilitating timeliness of access, potentially reducing the health technology assessment workload, mitigation of arbitrage risk and the partial preservation of indication-based pricing principles. However, the agreement also includes some contestable trade-offs and introduces unresolved challenges, such as weakening indication-level value signalling, constraining routine utilisation monitoring and distorting comparator pricing in future economic evaluations. Further, the agreement may alter evidence generation and shift decision-making responsibilities to other actors within the health system. We suggest that while a broad listing represents a pragmatic response to the growing prevalence of multi-indication medicines, it entails important trade-offs between access, transparency and value alignment. These design considerations are likely to be relevant for other jurisdictions considering similar reimbursement reforms.