Panadol Osteo decision could shift patients to opioids

Stakeholders have expressed disappointment in the PBAC’s restatement of its decision to delist Panadol Osteo, and concerns that patients may turn to stronger alternatives to manage their pain.

The PBAC says it assessed the issues raised in correspondence from stakeholders including the Pharmacy Guild and Painaustralia, but did not consider that there was any basis to revisit its earlier recommendations.

Painaustralia CEO Lesley Brydon told the AJP today that the organisation received no official advice about the decision to stick by the delisting, only an email last Friday that acknowledged its correspondence and contained a link to the March outcomes on the PBAC’s website.

“The decision will be disappointing for many people who regularly take Panadol Osteo as the first line treatment for osteoarthritis,” Brydon told the AJP.

“It is generally regarded as the least harmful option for people with chronic pain.”

She warns that the decision could have significant consequences down the track.

“If reducing costs in the health budget is the intention, then this could well be counterproductive,” she says. “The move may cause a shift towards more harmful alternatives.

“It is quite likely that patients, especially those on a concession, will turn to other PBS subsidised medication, including the low dose opioids.

“There is already widespread concern about the over-prescribing of opioids especially in lower socio-economic communities.”

The Australian Atlas of Healthcare Variation recently showed that the number of prescriptions for opioids was more than 10 times higher in the area with the highest rate compared to the area with the lowest rate.

Residents in parts of western NSW, western Victoria, rural areas of South Australia, some coastal regions of Queensland and the central highlands of Tasmania, were being prescribed opioids at rates of between 78,731 to 110,172 per 100,000 people.

This was in contrast with very different prescribing rates in areas of higher socioeconomic status and in major cities, including Sydney’s north shore and Melbourne’s eastern suburbs: much lower at 10,945 to 34,416 per 100,000 people.

“I understand the ACCC is currently investigating the manufacturer in relation to pricing issues… cost will certainly influence people to seek out more affordable options,” says Brydon.

The Guild wrote to the PBAC and Health Minister Sussan Ley in December and January raising its concerns about the delisting, including Quality Use of Medicine issues. Painaustralia and the Consumers Health Forum also raised concerns about the clinical and financial implications of delisting Panadol Osteo.

“We remain concerned that many sufferers of osteoarthritis will face an additional cost burden for their preferred medicine as they replace supplies purchased before I January,” says a spokesperson for the Pharmacy Guild.

In a media release earlier this year, Painaustralia said the cost of standard treatment with Panadol Osteo on the PBS (2 packs) for a patient on a concession card was $7.52 a month. This equated to $90.24 a year, less if the patient reached their Safety Net during the year.

Following the delisting the price increased to up to $14 a month for two packs off prescription, equating to $168 a year for these patients, as well as no longer contributing to their Safety Net eligibility.

But the PBAC says that as paracetamol 665mg tablets contain the same active ingredient as the 500mg immediate release form of paracetamol, six paracetamol modified release 665mg tablets are therapeutically equivalent to eight paracetamol 500mg tablets, which are less expensive.

“Panadol Osteo is possibly a more convenient form of paracetamol due to the less frequent dosing; it is generally taken three times per day whereas the 500 mg product is generally taken four times per day,” the PBAC noted.

“However, the 500 mg immediate release tablet is significantly less expensive than Panadol Osteo – a box of 100 tablets can be bought for as little as $2.

“The price at which Panadol Osteo is sold in pharmacy will now depend on a number of factors, including the choices made by GSK on de-listing its product from the PBS entirely.

“Further, the OTC price for all medicines varies widely from pharmacy to pharmacy. Anecdotally, Panadol Osteo is available at some pharmacies for $7.50 for 2 boxes, but does cost more than that at other pharmacies.

“A consideration of availability at a particular price OTC in pharmacy compared with the co-payment amount was not previously adopted by the PBAC.”

AJP reader Richard Lord echoed Brydon’s concerns that patients could be worse off if Panadol Osteo remains delisted.

“Osteoarthritis affects 60% of those over 65 years old and good pain management requires a baseline dose of two paracetamol tablets three times a day together with stronger opioid analgesics up to twice a day,” he wrote on an earlier AJP story on the subject.

“One complements the other and if you take away the paracetamol then the patient takes more opioid for pain relief with more side effects and health risks.”

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