PBS changes hurt the most needy: Guild


Schedule 3 - pharmacist holding out pill bottles

The Guild says patients should talk to pharmacy staff about PBS pricing changes which came into place on 1 January as it claims they may cause significant confusion among those patients most at risk.

In a statement it lambasted the optional $1 co-payment  discount and says the cost will be borne by pharmacy and consumers.

It claims:

  • The discount is  a budget cut, saving the government an estimated $373 million by delaying patient access to the Safety Net.
  • Concessional Card patients who reach the Safety Net – after which they become eligible for free medicines – are entitled to know that the effect of the discount will be to delay their access to free medicines, providing no net annual financial benefit to them. They will have to fill additional scripts in the year to reach the Safety Net threshold amount.
  • Concessional Card patients who take the discount must still spend the same total amount during the year to access free medicines on the Safety Net. If they take the discount their access to free medicines will start later in the year and the length of time they are eligible for free medicines will be reduced.
  • The Guild does not support – and has never supported – discounting of the patient co-payment, as it is contrary to the principle of a universal PBS. Clause 3.6 of the Community Pharmacy Agreement expressly states that this is the one aspect of the Agreement that the Guild does not support, and the Guild’s opposition to it was made clear to the Government throughout the negotiation.
  • While not supporting the discount, the Guild has always recognised that it is a matter for individual pharmacies to decide whether or not to offer the discount to patients.
  • As the Minister for Health recognised as long ago as April 2015, patients in rural areas may be less likely to be able to access the discount. This means that for the first time in the 50 year history of the PBS co-payment, Concession Card holders in different parts of Australia may pay different prices for subsidised PBS medicines.

In the light of these facts, any suggestions that all Concession Card holders win from the optional dollar discount are highly questionable at best, the Guild says.

It adds that those most vulnerable, the elderly and chronically sick will be subject to further stress due to the delisting of Panadol Osteo from the PBS.

  • As part of the 6CPA, the Guild agreed that selected medicines would be de-listed from the PBS on the clinical recommendation of the Pharmaceutical Benefits Advisory Committee (PBAC), based on the government’s commitment that these de-listed medicines would be available OTC at prices comparable or lower than what patients pay under the PBS.
  • Panadol Osteo is a recommended first-line therapy for the pain management of osteoarthritis. There are an estimated 1.9 million sufferers of this chronic health condition in Australia.
  • The Pharmacy Guild wrote to the PBAC on 17 December asking for a review of the de-listing of Panadol Osteo because it is clear it is not generally available to patients cheaper over-the-counter at the PBS subsidised maximum quantity for one month’s supply (192 tablets which is 2 packs of 96 tablets) and will cost sufferers of chronic pain significantly more per year.
  • Even before the GlaxoSmithKline price rise on 1 January, the ex-manufacturer price for 2 packs of 96 Panadol Osteo ($8.56) was higher than the amount paid by a Concessional Card holder under the PBS ($7.52).  The Guild queries if the PBAC compared the ex-manufacturer price of only 1 pack of 96 Panadol Osteo ($4.28) to the PBS Concession patient co-payment ($7.52) when the PBS maximum quantity for one month’s supply is actually 2 packs.
  • Regardless, it is clear that the de-listed Panadol Osteo will not be available over-the-counter at a comparable cost to patients, especially as GlaxoSmithKline has increased the ex-manufacturer price from 1 January by $2.03 per 96 pack to $6.31 ($12.62 for the PBS maximum quantity of 2 packs for a month’s supply).
  • The Guild alerted government officials during the Agreement negotiation that such ex manufacturer price rises had occurred with previous de-listings from the PBS.
  • Many people with chronic, debilitating osteoarthritis will pay significantly more for their treatment.  For example, Concession Card holders who normally reach the Safety Net in August previously paid $60.16 a year for their Panadol Osteo under the PBS. They will now pay an estimated $180 a year, tripling their annual out-of-pocket costs.
  • As Panadol Osteo is de-listed from the PBS, it also no longer counts towards the Safety Net, meaning that Concessional Card holders will have to purchase more PBS medicines before reaching the Safety Net. This further delays their access to free medicines.

“This combination of changes to the PBS from 1 January means the sickest and neediest in our community – those with chronic illnesses such as osteoarthritis who normally reach the PBS Safety Net – will have their access to free medicines delayed and will pay more for their essential pain relief medicines. These patients will be worse off, and this bad policy should be reviewed and reversed.”

The Guild says patients should ask their pharmacist about significant changes to PBS pricing arrangements and listings from 1 January, which may cause confusion among consumers.

The Guild says:

  • The cost of the discount is borne by the pharmacy, not the government.
  • The discount is in fact a budget cut, saving the government an estimated $373m  by delaying patient access to the Safety Net.
  • Concessional Card patients who reach the Safety Net – after which they become eligible for free medicines – are entitled to know that the effect of the discount will be to delay their access to free medicines, providing no net annual financial benefit to them. They will have to fill additional scripts in the year to reach the Safety Net threshold amount.
  • Concessional Card patients who take the discount must still spend the same total amount during the year to access free medicines on the Safety Net. If they take the discount their access to free medicines will start later in the year and the length of time they are eligible for free medicines will be reduced.
  • The Guild does not support – and has never supported – discounting of the patient co-payment, as it is contrary to the principle of a universal PBS. Clause 3.6 of the Community Pharmacy Agreement expressly states that this is the one aspect of the Agreement that the Guild does not support, and the Guild’s opposition to it was made clear to the Government throughout the negotiation.
  • While not supporting the discount, the Guild has always recognised that it is a matter for individual pharmacies to decide whether or not to offer the discount to patients.
  • As the Minister for Health recognised as long ago as April 2015, patients in rural areas may be less likely to be able to access the discount. This means that for the first time in the 50 year history of the PBS co-payment, Concession Card holders in different parts of Australia may pay different prices for subsidised PBS medicines.

In the light of these facts, any suggestions that all Concession Card holders win from the optional dollar discount are highly questionable at best, says the Guild.

The elderly and chronically ill are, in fact, the subject of further imposts through the de-listing from 1 January of one of the highest volume PBS medicines Panadol Osteo.

 De-listing of Panadol Osteo:

  • As part of the 6CPA, the Guild agreed that selected medicines would be de-listed from the PBS on the clinical recommendation of the Pharmaceutical Benefits Advisory Committee (PBAC), based on the Federal Government’s commitment that these de-listed medicines would be available over-the-counter at prices comparable or lower than what patients pay under the PBS.
  • Panadol Osteo is a recommended first-line therapy for the pain management of osteoarthritis. There are an estimated 1.9 million sufferers of this chronic health condition in Australia.
  • The Pharmacy Guild wrote to the PBAC on 17 December asking for a review of the de-listing of Panadol Osteo because it is clear it is not generally available to patients cheaper over-the-counter at the PBS subsidised maximum quantity for one month’s supply (192 tablets which is 2 packs of 96 tablets) and will cost sufferers of chronic pain significantly more per year.
  • Even before the GlaxoSmithKline price rise on 1 January, the ex-manufacturer price for 2 packs of 96 Panadol Osteo ($8.56) was higher than the amount paid by a Concessional Card holder under the PBS ($7.52).  The Guild queries if the PBAC compared the ex-manufacturer price of only 1 pack of 96 Panadol Osteo ($4.28) to the PBS Concession patient co-payment ($7.52) when the PBS maximum quantity for one month’s supply is actually 2 packs.
  • Regardless, it is clear that the de-listed Panadol Osteo will not be available over-the-counter at a comparable cost to patients, especially as GlaxoSmithKline has increased the ex-manufacturer price from 1 January by $2.03 per 96 pack to $6.31 ($12.62 for the PBS maximum quantity of 2 packs for a month’s supply).
  • The Guild alerted government officials during the Agreement negotiation that such ex manufacturer price rises had occurred with previous de-listings from the PBS.
  • Many people with chronic, debilitating osteoarthritis will pay significantly more for their treatment.  For example, Concession Card holders who normally reach the Safety Net in August previously paid $60.16 a year for their Panadol Osteo under the PBS.  They will now pay an estimated $180 a year tripling their annual out-of-pocket costs.
  • As Panadol Osteo is de-listed from the PBS, it also no longer counts towards the Safety Net, meaning that Concessional Card holders will have to purchase more PBS medicines before reaching the Safety Net. This further delays their access to free medicines.

“This combination of changes to the PBS from 1 January means the sickest and neediest in our community – those with chronic illnesses such as osteoarthritis who normally reach the PBS Safety Net – will have their access to free medicines delayed and will pay more for their essential pain relief medicines. These patients will be worse off, and this bad policy should be reviewed and reversed.”

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