Access concerns as drugs delisted

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The removal of some low-cost over-the-counter drugs from the PBS meaning that consumers will instead access these medicines from pharmacies and supermarkets, at notionally cheaper prices with the measure expected to save $500 million over five years.
The PBS Access and Sustainability Package, of which 6CPA is a part, has now been passed by the Government and is estimated to achieve PBS savings of $6.6 billion over the five years.
In April, the PBAC recommendation included that “products with an ex-manufacturer price below the PBS Concessional co-payment should be delisted from the PBS” because PBAC considered that “access to these products would be unaffected by the removal of PBS subsidy."
There are reportedly 352 ‘candidate’ items of which 47 were on the list for consideration by the PBAC in July.
Joe DeMarte is the newly elected President of the Pharmaceutical Society of Australia. The PSA appreciates that the determination of delisting criteria is being undertaken with the best advice and transparent processes, however we believe that broader consultation of stakeholder views should have been forthcoming.
“Access” is certainly not the only consideration here and PSA has raised concerns about the delisting measures by using paracetamol, an inexpensive and widely available OTC pain medicine, as an example.
Paracetamol - when prescribed on the PBS for osteoarthritis - is frontline therapy for 1.9 million Australians suffering with this condition.
When paracetamol is delisted, these consumers will reach the Safety Net later and experience greater out-of-pocket costs as paracetamol will no longer contribute to reaching the Safety Net.
To access the dose required for regular use in osteoarthritis from a supermarket, consumers would need to purchase multiple packets and take more tablets each day.
Even from a cost perspective alone these consumers would appear to be worse off, but of additional concern is that supermarket purchases take the GP and pharmacists out of the loop, fragment treatment and affect the quality use of medicines for many of these patients.
Paracetamol will no longer be recorded in a patient’s dispensing history and so pharmacists will no longer be able to effectively monitor compliance, check dosage or check for doubling up of paracetamol containing products that may have been inadvertently prescribed.
None of the above data, which would normally have been recorded during the process of dispensing, will be recorded anywhere and doctors will not be able to liaise with pharmacists to in order to access it if needed when reviewing a patient’s care.
Instead they will need to rely on the patient’s own assessment of their drug usage and compliance, and we all know that this is often an unreliable reference point.
Paracetamol was previously delisted from the PBS 1986, and unfortunately we do not appear to have learned from this previous delisting, which was reversed after only 12 months due to unexpected problems arising from the delisting.
PSA also has significant concerns with the implementation date for any resulting changes being scheduled for 1 January 2016.
These patients are mostly concession-card holders and patients with chronic conditions. A longer transition time needs to be considered so that people can organise their medical appointments and have their medicine needs re-assessed and/or alternatives considered. Making dose adjustments or understanding changes to their medication management plan may also take time.
Community pharmacists know from previous experience that significant changes to PBS rules creates a number of problems for patients and carers: confusion: ('‘I never had to pay for these medicines before'’), inconvenience: (“the clinic is not open or my own doctor is not available”) and distress (“I am away on holidays and need my medicines'’).
[caption id="attachment_14835" align="alignright" width="300"] Joe DeMarte
President of the Pharmaceutical Society of Australia[/caption]
A lead-up period of five months (at best) is far from adequate.
Our preference, and one we will continue to advocate for, is a commencement date of 1 July 2016.
As an aside and somewhat ironically, the National Return and Disposal of Unwanted Medicines (NatRUM) program recently reported that paracetamol was the eighth most commonly discarded medicine in Australia.
Surely pharmacists would be far better employed using their time to optimise medicine use, increase health literacy and minimise waste rather than trying to explain this additional legislated burden on people’s health, particularly those who are elderly, frail or have a chronic condition.