Be ready for 2016 changes: Quilty


$1 pharmacy discount: single dollar coin

As 2016 looms, community pharmacies need to be prepared for the optional $1 script copayment discount, and the delisting of several medicines from the PBS, Guild executive director David Quilty has warned.

In this week’s edition of Guild newsletter Forefront, Quilty highlights that from 1 January, pharmacies have the option to discount their patients’ co-payments on eligible PBS and RPBS prescriptions by up to $1 per script.

Both this and the delisting of some PBS items will have an impact on the contribution of patients’ out-of-pocket costs to their Safety Net entitlement threshold, Quilty says.

“In the case of the discount, the amount up to $1 that is able to be discounted by the pharmacy from the official patient co-payment will not count towards the patient’s Safety Net threshold,” he reminds Guild members.

“This means, for example, that if a Concessional patient receives the full $1 discount on all their eligible prescriptions, they will need to fill an additional 11 scripts during the year before they are able to access free medicines on the Safety Net.

“While receiving the upfront benefit of the discount, a Concessional patient will pay the same total out-of-pocket amount for their PBS or RPBS medicines over the calendar year to reach the Safety Net.

“With the amount that is discounted not counting towards the Safety Net, these patients’ access to free medicines will commence later in the year and will be for a reduced period of time.”

Quilty says community pharmacies need to discuss these issues with their Safety Net patients who express interest in the discount, so they are fully informed about the pros and cons of the change.

“At the end of the day, it is a matter for each pharmacy to decide whether to discount, what the size of the discount up to a maximum of $1 will be, and which patients will receive the discount,” he writes.

The Guild is providing a range of materials to its members to assist with the likely patient interactions on the discount, with a particular emphasis on Concessional patients who normally reach the Safety Net. These are available on the members’ only portal of the Guild’s website.

“At the same time, it is important that community pharmacies are fully informed about the medicines  being de-listed from the PBS from 1 January and what this means for their patients,” Quilty writes.

These include a range of paracetamol products (including Panadol Osteo), certain aspirin tablets, chloramphenicol eye products, hydrocortisone skin creams and ointments, iron/folic acid supplements, electrolytes, urine test strips and Vitamin B12 injections.

“Because they are being delisted, these medicines will no longer count towards a patient’s PBS Safety Net threshold,” says Quilty.

“However, there are exceptions with palliative care patients, Aboriginal and Torres Strait Islander people and Repatriation (Veterans’ Affairs) patients continuing to have subsidised access to these medicines.

“Upon the clinical advice of the Pharmaceutical Benefits Advisory Committee, the Government has decided to delist these medicines on the basis that they are available over-the-counter at comparable out-of-pocket costs to patients.

“For pharmacies, it will be important to continue helping their patients to manage the health conditions for which they have been using these medicines.”

As there is no Government contract regulating the manufacturers’ prices for these medicines, out of pocket costs to patients may change, with no guarantee or requirement that they be sold at or below the patient co-payment levels, he says.

“However patients should be able to access these medicines without a prescription or alternatively should be encouraged to have their condition and treatment reviewed by their doctor.

The Guild has also produced materials to support pharmacies to manage this change.

 

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