Pharmaceutical Benefits Scheme In Australia

History of the Pharmaceutical Benefits Scheme

Discuss about the Procedure Guidance for Listing Medicines.

In the year 1948, a limited scheme by the name pharmaceutical benefits scheme was established and started its operations in Australia. The scheme offers free medicines for all pensioners together with the free supply of 139 life-saving drugs and disease preventing medicines to community members. The scheme has grown tremendously and currently, it offers affordable, timely and reliable access to the necessary medicines for all Australians. It thus forms part of the Australian government national medicines policy (Lopert, 2009). Through the scheme, the aim of the national medicines policy which is meeting medication and related service needs of its citizens is achieved with a lot of ease. In the long run, both economic objectives and optimal health outcomes are achieved. 

It’s under this scheme that the government is able to offer subsidies to the cost of medications for many medical conditions. Pharmacists dispense most of the listed medicines that can be used at home by patients however some medicines can only be administered in the presence of an experienced medical officer such as chemotherapy drugs and thus are only found with the hospital premises (Easton et al., 2009). Any Australian resident that holds a Medicare card is eligible to benefit from the scheme. Visitors from overseas countries where Australia has reciprocal health care agreement are also covered under the scheme. Such countries include New Zealand, United Kingdom, Malta, Netherlands, Belgium, Slovenia, Italy, Sweden etc. for veterans that are eligible; they need to present DVA cards alongside Medicare cards to benefit from the scheme. Dentists cannot prescribe the PBS items in general to their patients instead they possess dental schedule which is separate and can be used to prescribe the dental care medicine for the patients who are under the scheme.

This is also applicable to the optometric schedule for eye patients.  PBS also comes with a concessional benefit and for one to be eligible for this cover they need one of the following cards; health care cards, commonwealth seniors health card, pensioner concession card or DVA white, yellow or gold cards (PBS, 2018). Its therefore evident that this scheme offers an all-around cover to different people and medical conditions with a subsidized price on medicines making it affordable for Medicare cardholders to get their conditions treated with less financial stresses. The scheme is however not perfect and its faced with some disadvantages and issues that need to be solved for better service and goods delivery to its beneficiaries.

Benefits of the Pharmaceutical Benefits Scheme

Overuse of medication; In the past decade, Australia has recorded the highest number of pharmaceuticals use among its residents. This, therefore, points out the benefits of having a medicine scheme like the PBS to cater for the costs that come with the use of drugs. This is a pointer to the fact that there is an increased number of illnesses among Australians or increased misuse of medicines by the population owing to the idea of a subsidized medical scheme (PBS, 2015). Inappropriate use can be detected from drug utilization data which is used to monitor of regulatory and educational interventions and guide on how the pharmacoeconomic analysis can be interpreted (Duckett, 2013).

The PBS and RPBS were established to offer communities and servicemen who returned from their missions’ affordable medication and products which have acceptable standards (Department of Health and Ageing, 2008). Since 2002 there has been an increasing outpatient number which has led to the increased addition of many medicines in the dataset for the patients. To prove an increase in the number of medical use by scheme beneficiaries, in the year 2014, highly specialized drugs data supply prescription has been on an increase in the database for discharged patients, admitted patients and outpatient ones. Any new medicinal group has to gain approval for supply in accordance with the therapeutic goods act 1989 and an approval required for indications of any established drug. 

Code	Year Ended June 30, 2002	Percent Change 2000 to 2002
Number of Prescriptions	Total Cost (In Millions)	Average Price	Number of Prescriptions	Total Cost	Average Price
Total	154,970,262	5003.3	32.29	4.7	9.6	4.7
Alimentary Tract and Metabolism	19,082,701	692.4	36.28	6.4	7.4	0.9
Blood and Blood Forming Organs	4,023,864	111.9	27.8	12.3	38.5	23.3
Cardiovascular System	46,587,011	1556.9	33.42	5.3	8.7	3.2
Dermatologicals	2,934,367	81.2	27.68	-2.7	1.1	3.9
Genito Urinary System and Sex Hormones	6,323,714	159.8	25.27	2.7	20.4	17.3
Systemic Hormonal Preparations, Excluding Sex Hormones	2,304,729	30.2	13.09	3.9	8.1	4.0
General Anti-Infectives for Systemic Use	12,550,089	273.1	21.76	-1.1	2.9	4.0
Antineoplastic and Immunomodulating Agents	961,818	317.7	330.35	8.0	17.2	8.5
Musculo-Skeletal System	10,709,738	340.1	31.75	27.2	14.4	10.0
Nervous System	30,564,051	906.5	29.66	3.4	8.6	5.1
Antiparasitic Products, Insecticides and Repellants	910,580	8.9	9.81	0.4	2.4	2.0
Respiratory System	10,341,286	374.0	36.16	-6.5	7.3	14.8
Sensory Organs	6,779,904	104.0	15.33	4.4	8.1	3.6
Various	602,127	43.6	72.41	5.7	5.4	-0.3
Not Otherwise Classified	294,283	3.1	10.58	-6.5	0.0	6.9

With the PBS the contributions made by patients towards their medication, are often capped (MacLennan et al., 2006). In the year 2015, the cost of a prescription to a general patient was to a maximum of $ 37.70, the pensioner and concession patients paid $ 6.10 per a prescription given. People with high medical need are protected by a safety net scheme. In 2015 the moment a patient and their immediate family member beneficiaries incurred $ 1,453.90 of their PBS expenditures, the remaining part of their prescription for the year only cost $ 6.10 per a prescription. The cardholder threshold for pensioners and other concession stands at $366 and once one reaches their maximum limits all the remaining prescriptions are received for free (Australian Institute of health and welfare, 2014).

In the event that a doctor prescribes a more expensive drug to a patient and yet there are cheaper brands covered by the same scheme, the extra cost is burdened on the patient as a surcharge. Many drugs are also not available on the PBS and some patients are forced to pay the full cost despite having the Medicare card (PBS, 2015). The cost of pharmaceutical drugs in Australia is relatively high depending on the sickness and doctors drug prescriptions. It’s evident that not all the medicines are listed on the PBS and thus any patient who may need a drug out of the system is forced to pay for the bill at a private cost which is definitely high (Hill et al., 2001). However, the scheme is quite beneficial to its members especially those that require a lot of medicines and may end up exhausting their annual covers. The scheme ensures such patients receive their drug supplies at a subsidized fee of free of charge for the remaining days of the year (Grove, 2016).

Eligibility for the Pharmaceutical Benefits Scheme

Types of medicine consumed; Under the scheme, there are general medicines which are dispensed by the pharmacies in the community and used at home by patients. The veteran medicines are offered to eligible veterans through the RPBS plan administered by the DVA and they are listed on the DVA in addition to wound care products (Goddard, 2014). The medicines with special arrangements under section 100 of the NHA are only supplied through special arrangements. Some require special storage, dispensing and monitoring and need to be administered in a hospital setup. They may fall under the highly specialized drug program, efficient funding of chemotherapy etc.

Issues with PBS and what can be done differently; the main problem with this scheme is that it does not offer comprehensive drug cover; there are situations in which a patient has to pay for their medication if the drug prescribed is lacking on the PBS list of drugs. Some patients dealing with an illness that require a lot of drugs exhaust their cover before the year ends and are forced to pay out of their pockets to get the drugs this hover excludes the pensioners who receive free medicines even after exhausting their annual covers (Department of Health, 2016). The scheme is only available to citizens that posses a Medicare card and for the visiting people from other countries they may not benefit from the cover if their countries do not have a memorandum of understanding regarding the cover with Australia. For the cover to be effective, it has to include all the citizens whether they possess a Medicare card or not and it should be open to the visiting people from other countries (Duckett, 2004).

Conclusion

From the discussion herein, it’s clear that PBS has played a crucial role when it comes to reducing the burden of medication to Australian citizens. The subsidies have enabled many citizens to receive quality treatment for their sicknesses.

However, the reduced medical costs come with the possibility of drug misuse as projected by increased use of pharmaceuticals by the citizens.

The government has to put in measures ensuring the citizens get drugs only for properly diagnosed illnesses.

The PBS has to be comprehensive and cater to the needs of the patients throughout the year, this will ensure those suffering from chronic or terminal illnesses are not disadvantaged once their cover is exhausted

The cover should be open to acquisition by any visiting person from other countries and not just those that Australia has entered an agreement with

Drug administration should be done only under the recommendation of a qualified medical practitioner to avoid over usage and misuse of pharmaceuticals as projected by statistics

	Demand	Supply
Price	Patient co-payments. Encourage prescription of “generic” (non-brand name) drugs. Encourage prescription of alternative medication in same therapeutic class.	Negotiate prices based on lowest in other countries.
Volume	Patient education programs.	Incentives on medical profession as a whole to limit prescribing. Practice guidelines. Limit inclusion on the approval list through use of cost effectiveness analysis. Provide education program to pharmacists, doctors.

SOURCE: Duckett, 2004.

References

Australian Government (2004). National Health Amendment (Pharmaceutical Benefits Budget Measures)Act2004.Retrievedfrom https://www.legislation.gov.au/Details/C2004A01353.

Australian Institute of health and welfare (2014).Health Expenditure Australia (2013-14). Health             and welfare expenditure series Number 54

Amanda, B. (2003). The Pharmaceutical Benefits Scheme an Overview E-Brief: Online Issue.     Retrievedfromhttps://www.aph.gov.au/About_Parliament/Parliamentary_Departments/Pa            rliamentary _Library/Publications_Archive/archive/PBS Accessed April, 20, 2018.

Department of Health and Ageing (2008). Australian statistics on medicines 2006.             Canberra: Commonwealth of Australia, 2008.

Department of Health (2016). Procedure guidance for listing medicines on the Pharmaceutical           Benefits Scheme. 2016. https://www.pbs.gov.au/info/industry/listing/listing-steps.  Accessed April 20, 2018.

Duckett, S.J. (2004). Drug Policy Down Under: Australia’s Pharmaceutical Benefits Scheme,

Health Care Financing Review, 25(3):55–67.

Duckett, S., Breadon, P., Ginnivan, L. and Venkataraman, P. (2013). Australia’s bad drug deal: high pharmaceutical prices. Melbourne: Grattan Institute. Retrieved from https://grattan.edu.au/wp-content/uploads/2014/04/Australias_Bad_Drug_Deal_FINAL.pdf

Easton, K., Morgan, T. and Williamson, M. (2009). Medication safety in the community: a             review of the literature. Sydney: National Prescribing Service, 2009.             https://www.nps.org.au/research_and_evaluation/current_research/medication_safety_community/complementary_medicines_report Accessed April, 20, 2018.

Goddard, M.S. (2014). How the Pharmaceutical Benefits Scheme began. Med J Aust. 201:1944- 1946. doi:10.5694/mja14.00124.

Grove, A. (2016). The Pharmaceutical Benefits Scheme: a quick guide; Research paper series, 2015–16; In parliamentary library information analysis advice

Hill, S.R., Stevens, A. and Henry, D.A (2001). A Review of the Use of Evidence in the PBS;  in D.M. Fox and A.D. Oxman (eds.), Informing Judgement: Case Studies of Health             Policy and Research in Six Countries (New York: Milbank Memorial Fund, 2001).

Lopert, R. (2009). Issue Brief: Evidence-Based Decision-Making Within Australia’s     pharmaceuticalbenefitsscheme.Retrievedfromhttps://www.commonwealthfund.org/~/medi   a/files/publications/issuebrief/2009/jul/chalkidou/1297_lopert_cer_australia_issue_brief_            724.pdf.

MacLennan, A.H. Myers, S.P. and Taylor, A.W. (2006). The continuing use of complementary and alternative medicine in South Australia: costs and beliefs. Med J   Aust, 184: 27-31.

Pharmaceutical Benefits Scheme (PBS) | The department of health, Australian Government (2015). Retrieved 20 April 2018 from  https://www.health.gov.au/PBS 

Pharmaceutical Benefits Scheme (PBS) | (2018). The pharmaceutical benefits scheme; Australian government department of health. Retrieved 20 April 2018 from https://www.pbs.gov.au/info/about-the-pbs Accessed April 20, 2018.