Call for opioid maintenance therapy copay on PBS

dollar coins in ascending rows (financial difficulty for opioid maintenance therapy patients)

Ensuring Opioid Maintenance Therapy is affordable for patients is an important strategy in helping stem prescription opioid and heroin addiction, a new report has found – but the current copayment for each dose compromises the therapy’s availability.

The Penington Institute is calling for the patient copayment for OMT to be provided to patients through the PBS.

“This will increase patient retention and uptake of OMT across Australia, resulting in better individual outcomes for illicit opioid users and reduced drug-related health and crime costs to the community,” it says in the report.

“Under the present system, it is cheaper and easier to procure prescription opioids than OMT.”

The copayment is a stand-out barrier to better outcomes for these patients, the report says, especially if patients are paying the roughly $10 a day to access services privately (pharmacies and GP patients pay anywhere between $1 and $10 daily).

It’s also an ongoing issue for pharmacists: these fees cover the pharmacist’s time, consumables, and general business costs, but may not actually cover the costs of OMT provision.

The report says that while cost to government is low compared to other forms of drug treatment, “OMT patients must carry the costs to pharmacists through program fees.

“Pharmacies are commercial enterprises. For these businesses to continue to provide OMT, it must remain financially viable”.

Program or dispensing fees have remained relatively stable for 20 years, but vary; the report points out that if a copayment per dose is $5, the weekly cost to patients would typically be $35: this remains the same whether the person has takeaway doses or attends the pharmacy every day.

“Pharmacists in most states receive no other payment for the provision of OMT, although there is a subsidy scheme in Tasmanian and the Australian Capital Territory and an inducement scheme in NSW,” the report says.

“Evidence suggests that consumer co-payments do not cover the costs of OMT provision. However, co-payments have remained relatively stable, presumably because of the struggle consumers have paying these fees.”

Many OMT patients have trouble meeting the fees, however: the Institute cited one study of 120 Victorian patients which found many prioritise OMT co-payment fees over necessities like food and accommodation, while other had to rely on emergency relief services to meet these needs. Yet others turned to crime to meet co-payments.

The payments often contribute to a deterioration in the relationship between dispensing pharmacist and patient, this study found, and accumulation of debt through the inability to pay dispensing fees is a primary reason for involuntary discontinuance of treatment.

Another study showed only a third of pharmacies reported all clients were up to date with their copayments.

“There is strong evidence that providing OMT co-payment relief to patients will improve program continuity and their relationship with their pharmacist, with a number of studies evaluating fee-subsidy models,” the report says.

“The evidence shows that providing OMT co-payment assistance will enhance OMT outcomes.

“With co-payment subsidies, patients have better retention on OMT and a more productive relationship with their pharmacist.

“Further, if pharmacists do not have to deal with people struggling to pay fees they may be more likely to provide OMT, thus enhancing treatment coverage and accessibility.”

The report recommends that methadone and buprenorphine (when used specifically for OMT) remain as S100 drugs, but with different provisions for supply.

The new provisions would be to:

  • Pay pharmacists a monthly fee per patient to cover the recording/dispensing fee, handling fee, counselling and pharmaceutical care; and
  • Require a monthly patient contribution. This would be $6 per month for those with a HCC and $36.90 for those without.

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