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Ten years of publicly funded biological disease-modifying antirheumatic drugs in Australia

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Access to high-cost medicines through the Australian Government’s Pharmaceutical Benefits Scheme (PBS) poses a number of challenges for the National Medicines Policy, which aims to provide timely access to medicines at a cost individuals and the community can afford. Biological disease-modifying antirheumatic drugs (bDMARDs) for rheumatoid arthritis (RA) were among the first highly accessed, high-cost drugs to be subsidised in Australia. To restrict their use, a unique subsidy scheme was developed by the Pharmaceutical Benefits Advisory Committee (PBAC), whereby physicians complete written authorities documenting both eligibility to initiate and response to permit continuation.1 Similar models have been adopted for other high-cost medications (eg, trastuzumab),2 but there is continuing debate on whether the medicines are available for all who need them, and what constitutes a “worthwhile” response for the individual and for the community who pay.3,4 In this article, we reflect on bDMARD use and the expenditure for newer bDMARDs for RA (abatacept, tocilizumab, certolizumab pegol and golimumab) (our methods are described in the Appendix). We suggest that an electronic database…