Access to very expensive drugs such as Hepatitis C medicines are one of several issues raised in the Pharmacy Remuneration and Regulation Review discussion paper, which examines the way payments for the drugs are made.
Among the 140 questions are three inquiring into whether the current arrangements could or should be improved.
A recent AJP poll showed that up to 30% of pharmacies might not offer the newly-listed Hepatitis C cures to patients because of the impact on the pharmacies’ business.
More than 20% were already not supplying them, with more pharmacies considering restricting their script numbers for these drugs or ceasing to offer them.
“Increasingly expensive medicines are being listed on the PBS, creating supply cost issues for both wholesalers and pharmacy,” the Review discussion paper states.
“New Hepatitis C medicines, in particular have presented challenges to current arrangements with significant cash flow issues through the supply chain.
“For example one hepatitis C medicine, Sovaldi, is $19,367 (plus GST). The mark-up for wholesalers is $69.94 to distribute this drug and the mark-up for pharmacy is $70 plus the dispensing fee.
“Additionally, payment timeframes from the wholesalers can be shorter than the reimbursement timeframe from the Commonwealth Department of Human Services back to the pharmacy.
“It has been put to the Panel that these pressures make pharmacists reluctant to stock these very high cost medicines and this in turn affects patient access.”
Question 22 asks: should the timeframes for payment settlements for very high cost medicines be lengthened throughout the supply chain and mandated by Government?
Meanwhile, Question 23 asks: Are there better ways of achieving patient access to very high cost medicines through community pharmacy that reduce the financial risks to the supply chain and facilitate consumer choice?
Consultant pharmacist Debbie Rigby, who with Professor Lisa Nissen and Chris Campbell developed the CPD accredited education package on the new drugs designed specifically for community pharmacy, told the AJP today that she “absolutely” welcomed the fact that these questions were raised by the King Review. Rigby is also on the advisory board for AbbVie, which supplies Viekira Pak.
“There will be more and more high cost drugs in the future, with biologics, hepatitis C drugs and other immunological drugs, so perhaps there needs to be a higher level exploration of the supply chain and the risk to community pharmacies,” she says.
Rigby pointed out that Gilead’s Harvoni had already become the top brand on the PBS for the 2015-6 year, despite having only come onto the PBS in March.
“The current remuneration to community pharmacy for Hepatitis C medicines does potentially limit patient access, because of the high risk of dispensing these medicines by the pharmacy business.
“The vast majority of community pharmacists want to do the right thing by the patient, but in some cases the risk their business is too great.”
She encouraged pharmacies which are not filling these scripts to refer to pharmacies who will, as “we’ve got a responsibility to ensure that the patient does have access to the medicines”.
“This is an issue right now, and will continue to be an issue into the future,” she warned, citing the example of a pangenotypic Hepatitis C treatment which has been FDA approved in the US and which may become available in Australia in the future.
Pharmacists are also likely to spend significant time collaborating with other health professionals and interacting with their patients when providing Hepatitis C medicines, Rigby says.
“They do have a lot of drug interactions, and in my discussions with GPs that’s one of the barriers to prescribing them,” she says.
“Pharmacists are underutilised, and this is an ideal opportunity to work in collaboration with GPs to determine if there are any significant drug interactions and how best to manage them, and if pharmacists are doing that maybe they should get more than $70.
“There’s a real paradigm shift at the moment, and hopefully out of this Review that pharmacists are providing quality care and collaborative care, remunerated appropriately.”
The Review also highlights the way Hepatitis C medicines are managed in hospitals, including the dual listing as s100 and s85 of the PBS.
“Remuneration for community pharmacies dispensing an s100 Highly Specialised Drug is less than that for the equivalent s85 general schedule item,” the report states.
“In the case of hepatitis C drugs, this means that hospitals are in effect paid an additional mark-up of around $2000 by the PBS when compared to being dispensed through a community pharmacy.”
However the question around this issue asks, “Should this remuneration structure for hospitals change to more closely reflect the remuneration structure of community pharmacy?” rather than aligning remuneration for community pharmacy with that of the hospital setting.