Palopegteriparatide (Yorvipath) is the first medicine that physiologically replaces the missing hormone in chronic hypoparathyroidism, and Australia's TGA was the first regulator worldwide to approve it after the FDA — yet two PBAC rejections in 2025 have left roughly 6,400–9,800 Australian adults tethered to a seventy-year-old calcium-and-vitamin-D regimen that controls a blood test while driving the kidney damage, neuropsychiatric symptoms and quality-of-life impairment documented in every major international cohort. The PaTHway trial now has three-year data showing 96% of patients remain independent of conventional therapy and mean eGFR has risen by 8.8 mL/min/1.73 m², with the largest gains in those with the worst baseline kidney function; Germany, France, the UK, Japan and the US have all moved to reimbursement while Australia has not. The PBAC's concerns were legitimate — ICER, surrogate endpoints, time horizon and limited Australian data — but each is answerable through instruments the Committee has itself built for rare-disease decisions: a confidential Special Pricing Arrangement, a Risk-Sharing Arrangement with expenditure caps, narrow initiation criteria aligned with the 2025 ESE guideline, explicit stopping rules, and a sponsor-funded Australian Hypoparathyroidism Registry. The article makes a respectful, specific case for a third submission framed as a Managed Access Program modelled on the Zolgensma and ivacaftor precedents, and calls on clinicians, patient organisations and affected Australians to coordinate their comment at the next consultation window.