Changes to PBS

Changes to PBS

Patients are urged to ask their pharmacist about significant changes to Pharmaceutical Benefits Scheme (PBS) pricing arrangements and listings from 1 January, which may cause confusion among consumers.

The Australian Government has legislated that from 1 January 2016 the patient co-payment for dispensing prescriptions for medicines subsidised under the PBS can be discounted by up to one dollar.

Here are some facts about the optional $1 discount:

  • 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 $373 million by delaying patient access to the Safety Net.
  • Concession 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.
  • Concession 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.
  • 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 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.

Here are some facts about the de-listing of Panadol Osteo:

  • 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.
  • Even before the GlaxoSmithKline price rise on 1 January, the ex-manufacturer price for 2 packs of 96 Panadol Osteo was higher than the amount paid by a Concessional Card holder under the PBS.   Government officials were notified 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 Concession 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.