The benefit of buying in bulk

Should pharmacists be offering advice to chronically ill patients to use bulk non-PBS prescriptions?

The cost burden of PBS medicines is such that prescribers and pharmacists should consider making chronically ill patients aware of the benefit of bulk non-PBS prescriptions, says a health economist.

Writing in the latest Medical Journal of Australia, Associate Professor Susanne O’Malley says: “I am aware that it is not the responsibility of prescribers or pharmacists to give cost-saving advice when prescribing or dispensing medications.

However, considering the growing number of self-funded retirees, perhaps chronically ill patients could be made aware of the potential to mitigate some of the financial burden of their prescription medications by using bulk non-PBS prescriptions”.

“It may also be time for a review of PBS prescriptions for pharmaceuticals used by the chronically ill to allow these drugs to be dispensed in amounts covering more than a single month’s supply,” adds Associate Professor O’Malley, a health economist at Macquarie University, Sydney.

Using calculations on the cost of four long-term medications she takes – prednisone, beclomethasone dipropionate, salbutamol and pantoprazole – she calculates an annual saving of $396.17 by not using the PBS.

This is “more than a dollar a day” she says, and “does not include the savings from unnecessary trips to the pharmacy.”

“Although this annual saving is based only on my own medication regimen, any patient who is on any long term medication that has a maximum price to consumer below the current safety net can also save by using bulk non-PBS prescriptions.”

Use of these bulk prescriptions was subject to a number of caveats such as patients having an established, ongoing clinical need to avoid wastage and money, also the expiry date of the medications needs to allow for the time required to use up the supply.         

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  1. Karalyn Huxhagen

    Interesting debate. With PBS safety net cap climbing each year and the safety net recorded fee for many prescriptions dropping each time we enter a a price disclosure term there are less and less general patients reaching PBS safety net. Many pharmacies already price PBS medicines as private prescription items to be able to give the low retail prices that price match the discounters. The question still remains that if the GP writes the prescription as a PBS item are pharmacists supposed to dispense these items as PBS? In practice we are asked to price match to the discounters more often since the ridiculous $1.00 off PBS fiasco.
    My concern is also storage conditions,acess to medication by others, expiry dates and change of medication. Even though your disease may be chronic there is always that new drug or an exacerbation of the disease that can cause changes to be made to the most stable of regimens. I certainly look at this issue for areas such as Stemetil 5mg 25’s Vs a pack of 100 for a patient on regular Stemetil but I am reluctant for a patient to have 120 Ms Contin 100mg at home. Very clever burglars watch areas such as pain clinics and hospital pharmacies and steal the opioids from patients houses. They never take the antihypertensives or cholesterol lowering meds which always makes me comment to the police that we have healthy burglars in our area.

  2. John Guy

    Karalyn points out that PBS safety net should be factored into this calculation.
    What exactly is meant by ‘buying in bulk’?. If a prescriber orders a given quantity with repeats, this should be observed as to supply the whole amount at once would go against PBA Guidelines for Dispensing (see Guideline 3).
    The example given of bulk dispensing of Stemetil is not an ideal one as you may query if Stemetil should be used in large amounts and long term.
    Prescribers are free to write scripts outside PBS restrictions and this is a discussion that needs to occur between them, the consumer and probably the pharmacist.

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