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Painkillers to go off-script in the hunt for savings

The AMA has warned vulnerable patients must not be hurt in the Federal Government’s drive to achieve huge savings from the Pharmaceutical Benefits Scheme.


The Federal Government is considering an option to save up to $3 billion from the PBS by axing prescriptions for over-the-counter painkillers and other medicines and allowing pharmacists to offer discounts on the patient co-payment.

In a major shake-up to the PBS as negotiations over the multi-billion dollar Community Pharmacy Agreement intensify, Health Minister Sussan Ley has revealed the Government is looking at removing from the scheme Panadol, aspirin, antacids and other medicines that can be bought without a prescription.

While such medicines can be cheaply and readily bought from supermarkets and other outlets, many patients are currently purchasing them through the PBS to help them quickly reach the safety net threshold – $1453.90 for general patients and $366 for concession card holders – after which all medications are free.

But the Australian Medical Association has cautioned of the risk of harm to patients if the Government’s principle focus was cost-cutting.

AMA Vice President Dr Stephen Parnis said doctors wanted to be sure that, in any changes, “the most vulnerable groups are protected”.

Ms Ley told the Australian Financial Review the PBS contained a number of “perverse disincentives and some perverse incentives” that were costly for both the Government and patients.

“The Government is paying a lot of money for people to access Panadol and other over-the-counter medications at their chemist on script,” the Minister said. “There’s a really strong argument why, under the supervision of the Pharmaceutical Benefits Advisory [Committee], we look to taking over-the-counter medications off the Pharmaceutical Benefits Scheme, and in the process get a better deal for consumers.”

In addition, the Government is considering allowing pharmacies to offer a co-payment discount of up to $1 per prescription for patients who opt for cheaper generic versions of their medicines.

The measure would serve two purposes – to encourage greater use of generic medicines and so save money for the PBS, and to slow down the speed with which patients reach the safety net threshold.

Ms Ley told the AFR that “allowing pharmacies to reduce what patients pay is one of the key ingredients that I want to see come out of this [Community Pharmacy] Agreement: that medicines remain affordable”.

But, as the AFR pointed out, both proposed changes sit at “extreme odds” with measures adopted in last year’s Budget to increase the PBS co-payment and the safety net thresholds, for a claimed saving of around $1.3 billion over four years. Legislation enshrining the changes is yet to be passed by Parliament.

They also come as the Therapeutic Goods Administration’s Advisory Committee on Medicines Scheduling considers whether to make many common painkillers sold by pharmacists available by prescription only.

It has been proposed that about 150 codeine medications including Mersyndol, Codral Cold and Flu Tablets, Nurofen Plus and Panadeine, currently available over-the-counter at chemists, be reclassified at schedule 4 medicines, which would mean they could only be dispensed with a prescription.

The change has been recommended amid reports an increasing number of patients are taking excessive quantities of codeine, often in conjunction with ibuprofen, causing severe gastrointestinal damage and internal bleeding.

Australians are heavy users of pharmacy-only codeine products – more than 1.3 million packets are sold each month – and more than 1000 people were treated for codeine dependency in 2012-13.

The proposed changes come amid negotiations between the Government and the Pharmacy Guild of Australia over the next Community Pharmacy Agreement, which is due to come into effect from 1 July when the current $15.4 billion deal expires.

The Guild has been pushing for an enhanced role for pharmacists, including administering flu vaccinations and conducting health checks, to help offset reduced income growth from the dispensing of medicines under the Commonwealth’s price disclosure arrangement with drug manufacturers.

But the Guild’s bargaining position has been undermined by an Auditor-General’s report scathing about the current agreement, including revelations that funds earmarked for professional development had instead been diverted into a “communications strategy”.

Adrian Rollins