Healthy Skepticism Library item: 1767

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Publication type: news

Health Fact Sheet 1 – Securing the future of the Pharmaceutical Benefits Scheme
2002 May 14

Full text:

Securing the future of the Pharmaceutical Benefits Scheme
The Government is committed to securing the future of the Pharmaceutical Benefits Scheme (PBS). The Scheme has provided subsidised access to a range of medicines for more than 50 years, and is a key part of Medicare.

The PBS is continuing to grow rapidly (an average of around 14% per annum over the last 10 years) which is challenging its long-term sustainability. The measures announced in this Budget Include:

Improving evidence-based quality prescribing
New medicines are included on the PBS on the basis of their clinical and cost effectiveness. To ensure that medicines are prescribed effectively the PBS includes rules on when, and for what conditions, some medicines are prescribed.

The Budget measure Reinforcing the commitment to evidence-based medicine includes a number of initiatives which will improve these rules and ensure that doctors prescribe within them.

PBS listing process

A more detailed assessment will be made of new drugs to be listed and there will be clearer conditions put on their use.

There will be a focus on improving the Government’s capacity to assess financial estimates for new drugs being listed on the PBS. The Pharmaceutical Benefits Advisory Committee’s ability to track and monitor the use of medicines will be enhanced.

Prescribing criteria

Support to doctors will be improved to ensure that they have a clear understanding of the evidence for quality prescribing, and the criteria that must be satisfied before they prescribe a medicine subsidised under the PBS. This measure does not interfere with doctors’ clinical judgement. If the PBS criteria are not met, the doctor has the choice to prescribe outside the PBS. Health Insurance Commission audit, investigation and counselling procedures and information for doctors and consumers will also be improved.

Prescriptions needing Health Insurance Commission approval

In some instances doctors will be required to provide additional information in order to get approval to prescribe authority-listed PBS medicines. The information may include the date of pathology testing, the name of the hospital where treatment commenced and/or previous drug therapies.

From August 2003, doctors will be able to use on-line computer access to the Health Insurance Commission to allow them to request authority prescriptions electronically. This should result in more efficient use of doctors’ time in comparison with the current telephone approval system.

Support for doctors

GPs will be helped to prescribe PBS medicines in keeping with evidence-based quality prescribing by being encouraged to use clinical software that:

contains full information on the costs to both the consumer and the taxpayer of PBS medicines; and
includes evidence-based guidelines that support quality prescribing.

Community awareness program

An awareness campaign will be undertaken to inform the community of the high quality medicines system funded by taxpayers and provide them with independent information about new drugs or changes to the PBS.

A program will also be developed to provide information on a quarterly basis to doctors on evidence-based prescribing of new and revised PBS-listed medicines.

This range of initiatives under the Reinforcing the commitment to evidence-based medicine measure will generate net savings of $281 million over four years.

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Increased information provision to doctors
by industry
Pharmaceutical manufacturers have agreed to support the Government in providing information to doctors about medicines listed on the PBS. In the course of their contact with doctors, medical representatives from drug companies will inform them of the PBS prescribing requirements. PBS prescribing information will also be included in drug advertising material.

This measure will generate estimated net savings of $147 million over four years.

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Addressing pharmacy fraud
The Government will strengthen current approaches to identifying and investigating fraudulent and inappropriate pharmacy dispensing practices.

The vast majority of pharmacies which properly claim PBS refunds will not be affected.

This measure will generate net savings of $201 million over four years.

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Decreasing doctor shopping
This measure will build on current projects that aim to reduce the incidence of individuals obtaining clinically inappropriate medicines under the PBS. It will complement the pharmacy fraud measure activities.

This measure will improve identification of individuals who obtain a high number of prescriptions, enabling counselling of patients who are at high risk of drug-related health complications and reducing the incidence of prescription drug abuse.

This cost containment and public health initiative will provide net savings of $16 million over four years.

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Facilitating the use of generic medicines
The Government will continue to ensure the best price for medicines for the Australian community and will enter into an agreement with individual manufacturers of generic drugs. This will facilitate the use of generic medicines in return for a reduction in prices for these products.

The Government will regulate to ensure that computer-prescribing programs used by doctors enable the use of generic drugs unless the prescribing doctor consciously chooses the original brand name product.

This measure will be implemented from 1 November 2002.

It is estimated that this will result in savings of $111 million over four years.

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Review of drugs for the treatment of arthritis
The Government will ask the Pharmaceutical Benefits Advisory Committee to undertake a review of the latest evidence on the safety advantages of Cox-2 selective drugs, recently listed on the PBS for the treatment of arthritis. The results of this review will be used to determine whether the price currently received by pharmaceutical manufacturers for these drugs should be adjusted.

No provision for any price change has been included in the Budget estimates at this time.

Contact: (co-payments, safety nets, use of generic medicines, arthritis drugs)

Brett Lennon, Assistant Secretary, Pharmaceutical Benefits Branch, Health Access and Financing Division, (02) 6289 7085

Contact: (other measures) Allan Rennie, Assistant Secretary, Pharmaceutical Access and Quality Branch, Health Access and Financing Division, (02) 6289 8264