The Pharmaceutical Benefits Scheme, under which the government pays for pharmaceuticals along with a co-payment from consumers up to a threshold where the co-payment cuts out, is the second biggest item in the health budget.
Even after the government last year proposed to implement the National Commission of Audit’s recommendations on PBS and significantly increase the size of the co-payment, and lifted the threshold at which the co-payment cuts out, it would have cost $9.2 billion.
Neither change — they would have saved $2 billion a year — has yet made it through the Senate. The budget papers last year estimated the scheme would reach $10.2 billion in 2017-18, even with those savings. In comparison, the Medicare Benefits Schedule will cost $20.3 billion this year, while private health insurance rebate will cost $5.8 billion.
That’s why the government is keen to push simple over-the-counter medicines like pain relief off the PBS. A long-running gaming of the co-payment and cut-off threshold by pensioners involves getting a prescription from your doctor for a cheap over-the-counter medication so it counts towards the cut-off threshold, after which a pensioner stops paying the co-payment.
It is, as Health Minister Sussan Ley says, a perverse incentive within the system.
Purging such incentives from the PBS system augurs poorly for a push by nanny statists to make over-the-counter pain relief impossible to obtain.
Public health lobbyists, ever vigilant for opportunities to impose tighter surveillance and control on Australians, are looking to use abuse by a tiny number of consumers of pain relief products as the basis for banning access to drugs like Panadeine and Nurofen without a doctor’s prescription — something that would dramatically increase GP visits and PBS costs. Either that, or you’ll have to sit and suffer with herbal pain relief.
There’s an even better way to curb growth in the PBS. The National Commission of Audit recommended making people who’d reached the cut-off threshold continue to make a small co-payment ($2).
It also urged, as pretty much everyone else outside government for years has done, to deregulate the pharmacy industry, which the government appears keener to use as an implied threat to force pharmacy costs down through the negotiation of the next Community Pharmacy Agreement (the rort that locks in the pharmacy monopoly) rather than actually implement it.
And it recommended a more ruthless, streamlined approach to approving new additions to the PBS, which would last about as long as it took for someone to be blocked from accessing a new, lifesaving medication.
A better way would be to introduce further means-testing of the PBS co-payment (the net medical expenses tax offset, which includes PBS co-payment costs, is already means-tested) so that high-income earners would pay a higher co-payment than low- and middle-income earners, who in turn would pay a higher co-payment than pensioners, who would pay a higher co-payment than those who’d reached the cut-off threshold.
People like me — I’m a big PBS consumer — should have to pay more for our medicines than Australians on lower incomes. It would increase the potential effective marginal tax rate at whatever the income threshold was set at, especially for double-income couples with kids, but that could be addressed using the cut-off threshold, so that families with sick kids didn’t face a dramatic rise in chemist costs because of a small rise in income.
The more substantial impediment is effective implementation. A PBS IT system that shared in real-time information with the tax system and could identify high-income earners at point of sale would be highly intrusive and, judging by the e-health debacle, an IT disaster waiting to happen.
Alternatively, everyone could be charged a higher co-payment, and low- and middle-income earners permitted to claim the difference in their tax return. But the principle of means-testing the PBS co-payment is already in place and merits being extended so that the wealthy are subsidised by taxpayers via the PBS at a lower level than currently.
I’m guessing Bernard that you didn’t read the article you linked, which had a specialist in the field providing very prudent reasons for restricting codeine to prescription only.
1. Codeine is a very bad drug. For starters it’s actually a very poor analgesic and it offers little in addition to paracetamol and/or ibuprofen. It is not active itself, but requires conversion in the body by liver enzymes to morphine to exert it’s analgesic effects. The inactive pro-drug however still has many of the adverse effects, it is also highly addictive. Secondly up to 30% of the anglo-celtic population (little is known about people from other ethnicities) have ineffective or other variants of the enzyme that make codeine either a useless or unpleasant drug for them. 20% are “non-metabolisers”, this group do not convert codeine at all. They may as well take a placebo. 10% are either “rapid metabolisers”, or “hyper metabolisers”, with the former being the overwhelming majority. For both of these groups the body converts codeine to morphine at such a high rate that these people suffer significant stomach pains and often dizziness.
A new drug that had a 20% rate of being totally ineffective and 10% or more rate of significant adverse unpleasant side effects as well as being highly addictive would never get regulatory approval. Codeine’s time is up, it shouldn’t just be prescription only, it should have it’s listing in the Australian Register of Therapeutic Goods removed. This is unfortunately unlikely to happen as Big Pharma makes too much money from it and the TGA will roll over and let the pharmaceutical industry tickle their tummies.
2. A far better way of controlling PBS costs would be do adopt the NZ funding model. Only one or two drugs from each class is allowed, and drug companies tender to be the preferred supplier for a specified period, at the end of the period tenders are called again. All the “me too” drugs have to compete against the class leader (there is an allowance made for significant clinical differences). So instead of a large range of drugs sold for a high price you get a much more restricted range sold at the lowest tender. Drugs in NZ cost a fraction of what they do here. Big Pharma would scream that this would be the end of the world as we know it and Australians would be denied effective drugs. They all seem pretty keen to get the tenders in NZ, so I think we can dismiss those threats as the usual rent seeking that we have seen in this sector for eons.
Bernard, would you prefer to replace the ‘pharmacy monopoly’ with a pharmacy duopoly which is what has happened to the deregulating of the fuel and alcohol industries?
You already do pay more. I’ve been on a low income health care cards for a few years now, and now am on a pensioner one, and my scripts are $6.10 a box… before that I was paying up to $50/month for one of them
actually I take the $50/month back, it was the max rate of $36, but then I got to add my two others on at around $20/month.