Questions over the price of private prescriptions due to “commercial decisions by the pharmacist” as Senate tackles the question of medicine shortages
Federal Senators questioned Department of Health officials on how Australia is confronting the growing problem of medicine shortages, and the resultant impact on patients through the rise in costly private prescriptions.
Adjunct Professor John Skerritt, deputy secretary of the Health Products Regulation Group fronted the Senate Community Affairs committee during estimates hearings last week, with Senators asking questions around our response to medicine supply issues, especially in light of the pandemic.
Questions were also asked around the cost to consumers due to “commercial decisions by the pharmacist” when non-PBS medicines were supplied as alternatives.
Senator Rachel Siewert (Greens, Vic) said “It’s my understanding that we import about 90 per cent of our medicines and we’ve got a lack of capacity in terms of medicines development and manufacturing but also manufacturing of the ingredients, and of course that’s come into stark relief through the issues around the pandemic”.
She asked Dr Skerritt about Australia’s response to this, especially given “the details in the budget aren’t very clear”.
“There were initiatives announced just before the budget on an update to the manufacturing strategy.
Encouraging Australian manufacturers of innovative medicines and medical technology, medical device products, is one of the five or six main themes of that,” he responded.
“The health department is working closely with industry, but, because that program was only announced in budget, and it’s their [Department of Industry] program, it’s in early stages of design”.
“Our role is that we have overall management coordination on medicine shortages….we will have the ongoing responsibility to have a sense of where issues may arise when it comes to medicine shortages, what alternatives are, what the manufacturing issues are,” Dr Skerritt said. “We have a role in understanding what the capacity is.”
D Skerritt said a large stakeholder roundtable on medicine shortages in December 2019 identified 13 actions, with additional ones being identified during the pandemic.
“For example, from last month we have the ability to publish every single shortage, not just the serious and critical ones. We’ve managed to work towards getting a consensus. Industry often was nervous about publishing medicine shortages…. I think COVID has shown the enhanced goodwill between all stakeholders and also the enhanced willingness to share information,” he said.
“We’re getting information that we never had before on what the states and territories hold and have purchased, and that’s been really important during COVID”.
Senator Siewert then turned to the issue of increased costs to consumers from non-PBS medicines being issued on private prescription during shortages, asking “If it can’t then be included in the PBS, it results in increased cost to consumers”.
“It does,” Dr Skerritt responded. “One of the issues that pharmacists and prescribers communicate is the ability to prescribe or dispense alternatives. That could be just two tablets at half a dose of the same product. That discussion is encouraged. The clinical colleges do say: ‘Hey, at the moment this medicine is more expensive. Have the discussion and, especially if you’ve got a concessional patient, you might consider alternatives.'”
“The actual price at which a pharmacy dispenses any medicine on private prescription in Australia, including these medicines that come in on shortage, is a commercial decision by the pharmacist,” he said.
“From personal experience, I’ve paid between $40 and $100 for precisely the same prescription, but that’s a commercial decision by the pharmacist”.
Due to the commercial nature of sales figures on non-PBS medicines, he was unable to supply data on how many medicines were being dispensed, nor of costs
“Quite often the pharmacist or the doctor will say, ‘Hey, I can prescribe that for you, but it’s going to be private, and I think it’s about $70’ or whatever. They might say: ‘I could give you this. This is on the PBS, but I think this one has fewer side effects.’ And RACGP and AMA have increasingly been encouraging this discussion. What we don’t have is the statistics. As I said, the actual price at which it’s dispensed
for a private prescription is totally a commercial decision of the pharmacist,” he said.