PBS DISCUSSION PAPER
with
AMA Federal Council Resolutions
Prepared by: Dr Jennifer Thomson
Acting Director, Health Services
Mr Roger Kilham
Consultant Economist
Federal Secretariat
Australian Medical Association
42 Macquarie Street
BARTON ACT 2600
Tel: 02 6270 5400
Fax: 02 6270 5499
March 2002
AMA - PBS Discussion paper prepared by Jennifer Thomson & Roger Kilham Feb 2002
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AMA - PHARMACEUTICAL BENEFITS SCHEME (PBS)
DISCUSSION PAPER
Introduction
The Pharmaceutical Benefits Scheme (PBS) is an important plank of health care in
Australia. It has been in existence for 50 years during which time it has evolved from
a scheme for the provision of drugs for life threatening conditions to a scheme for the
provision of timely, reliable and affordable access to necessary and cost effective
medicines1.
The scheme is now looming as a large target for the attention of central expenditure
control Departments (Treasury and Finance) due to both its size and the rate of
growth of spending. The PBS cost $1 billion in 1987 and reached $4 billion in
2000/01.2 The trend rate of growth of spending under the PBS has been of the order
of 10 to 11% per annum (nominal), which equates to about 6 to 7% in real per capita
terms. However, in the year 2000-01, spending grew by about 19%, significantly
boosted above the trend rate by Ministerial decisions to list two new drugs (Celebrex
for arthritis, Zyban for anti-smoking). In the absence of listing of these new drugs, it
is likely that PBS spending would still increase in real per capita terms.
PBS growth
Many factors have been contributing to the rapid growth of PBS spending. These
include:
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Community expectations, including expectations of access to new and
sometimes very expensive drugs;
Expansion in effective drug treatments (which relates to community expectations,
prescribing patterns and listing of new drugs);
The ageing of the population;
Increasing costs of drugs, due both the changes in the composition of drugs
prescribed and to a movement towards world parity pricing;
The growth of the concessional schemes (which relates to increasing income
inequality in Australia);
Growth arising from higher rates of disease detection (eg diabetes); and
The growth of defensive medicine.
We might hope that policy would be informed by a full understanding of these factors
and an attempt to quantify their importance. In practice little information is shared.
There is some attempt by the Department to engage the wider community in a
constructive dialogue through the Australian Pharmaceutical Advisory Council
(APAC). It appears however that the requisite analysis of the PBS system is not
being undertaken. There is concern that Government has been telling GP groups
that GP prescribing habits are to be targeted with cost-saving measures in the next
budget. This is occurring without substantiating the presumption that GP prescribing
is the essence of the problem.
1
2
Australian National Audit Office. 1997, pg 5
Department Health & Ageing, 2001, pg 1
AMA - PBS Discussion paper prepared by Jennifer Thomson & Roger Kilham Feb 2002
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The nature of the problem is also being over-inflated by the Government. Huge
emphasis is placed on last year’s 19% growth.
However, the upsurge in
pharmaceutical spending is not limited to Australia by any means. Similar surges
have been seen in North America and in Europe (although the policy responses are
not the same). In the USA, spending on prescription drugs has increased from 6%
of national health spending in 1994 to 9.4% in 2000 (representing a growth rate of
over 14% p.a.). Private health funds in the US have rapidly increased their funding
of pharmaceuticals in the same six years (growing by 21.5% p.a.). It is particularly
interesting to note that public health funding of prescription drugs has grown even
faster than private health funding.
Furthermore, overall spending on pharmaceuticals in Australia is, if anything, below
average by international standards. On the latest comparable data available (late
1990s) Australia was spending 1.0% of GDP on pharmaceuticals, the UK 1.1%,
Japan 1.3% and the USA 1.4%. Some would say that Australia’s low spend relative
to GDP reflects the success of Australia’s funding systems in controlling spending.
The dilemma for Government is to find effective interventions that will maintain the
integrity of the scheme (and its very significant health benefits) whilst managing the
costs in an appropriate way.
National Medicines Policy
The PBS rests within the Department of Health and Ageing’s National Medicines
Policy, which was endorsed by the Council of Australian Governments3 in 1999. The
policy has four central objectives:
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“Timely access to the medicines that Australians need, at a cost individuals and
the community can afford
Medicines meeting appropriate standards of quality, safety and efficacy
Quality use of medicines
Maintaining a responsible and viable medicines industry”4
The Government has set up a Committee structure to advise on the implementation
of this policy including the Australian Pharmaceutical Advisory Council (APAC) to
enable a partnership approach with multi lateral and consensus development of
broad advice. The Pharmaceutical Health and Rational Use of Medicines Committee
(PHARM) together with the National Prescribing Service (NPS) have taken on a
more specific role in the quality use of medicines.
The PBS is the mechanism to deliver medicines to the community. The
Pharmaceutical Benefits Advisory Committee (PBAC) advises on which drugs should
be listed using cost effectiveness principles (from 1994 onwards) and with pricing
being determined by the Pharmaceutical Benefits Pricing Authority (PBPA).
AMA - PBS Discussion paper prepared by Jennifer Thomson &
Roger Kilham Feb 2002
3
4
Department of Health & Aged Care, 2000, pg 1
ibid pg 3
The PBS pathway/ system2
AMA - PBS Discussion paper prepared by Jennifer Thomson & Roger Kilham Feb 2002
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AMA - PBS Discussion paper prepared by Jennifer Thomson & Roger Kilham Feb 2002
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The pathway of drug regulation, listing and prescription is a complex system 5. The
steps include:
a) Application for product registration considered by the Australian Drug Evaluation
Committee (ADEC) of the Therapeutic Goods Administration (TGA). The basis
for evaluation is quality, safety and efficacy.
b) Product information and consumer information are developed and approved at
this point.
c) Application for listing on the PBS is considered by Pharmaceutical Benefits
Advisory Committee (PBAC) of the Department of Health & Ageing (DH&A). The
basis for evaluation is comparative safety, efficacy and cost-effectiveness. PBAC
determines any restrictions on prescribing including restricted benefits listing and
authority-required benefit listing which requires the prescriber to gain approval
prior from the Health Insurance Commission (HIC).
d) Products are then recommended to the Health Minister for approval.
e) The Pharmaceutical Benefits Pricing Authority (PBPA) then negotiates PBS listed
prices with the drug sponsor based upon information from PBAC.
f) The prescriber who will have been issued a prescriber number by the HIC is able
to prescribe drugs listed on the PBS. From this point government has little direct
control. Prescribers are largely medical practitioners operating within a unique
doctor-patient relationship where both parties are able to make independent
choices.
g) The patient will choose whether to have the script dispensed.
h) The pharmacist will dispense the script with or without consumer medicine
information.
i) The patient will then choose to use the medicine as prescribed or not.
j) Adverse drug reactions can be reported via the Adverse Drug Reaction Advisory
Committee (ADRAC).
Quality Use of Medicines
The Quality Use of Medicines has been one of the principal platforms of the National
Medicines Policy. In 1991 the Australian Pharmaceutical Advisory Council (APAC)
and the Pharmaceutical Health and Rational Use of Medicines Committee (PHARM)
were established in recognition of increasing rates of drug related morbidity and
mortality. Over the last 10 years these bodies have driven the Quality Use of
Medicines (QUM) policy development with the formation of implementation agencies
such as the National Prescribing Service (NPS). The NPS has been responsible for
education strategies to promote improved prescribing of medicines. Strategies have
included using innovative and successful education with general practitioners
particularly through Divisions of General Practice. Specialist doctors have received
limited attention although it is known that specialist impact on prescribing behaviour
of general practitioner is considerable in some cases. In a recent Australian study it
was shown for some drugs specialist initiation was high e.g. proton pump inhibitors
at 80%, for others low e.g. diuretics at 8 %.6
5
6
National Prescribing Service, 2001, pg 4
Robertson et al., 2001, pg 409
AMA - PBS Discussion paper prepared by Jennifer Thomson & Roger Kilham Feb 2002
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Some of the outcomes of the QUM strategies of the last decade have recently been
collated. For example, antibiotic use in Australia has been declining with evidence of
more appropriate use of antibiotics as well as non steroidal anti inflammatory drug
use for osteoarthritis 7
The NPS has a budget of $5 million per annum, a tiny amount compared to the
marketing budgets of drug companies.
Recent release of high cost new medicines onto the market without prior provision of
evidence-based information to the public or prescribers has made it impossible for
evidence-based decision making. Although direct marketing to the public of
prescription drugs is not permitted, marketing to the public through other means has
been highly successful in the release of some recent high cost medicines such as
Zyban and Celebrex.
The marketing methods to prescribers are numerous and effective. They include
pharmaceutical representative detailing and Drug Company sponsored education
and other activities.
PBS cost framework
The cost of the PBS is managed in various ways. While the PBS is currently
demand driven and uncapped, controls are in place at various points in the system:
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7
8
PBAC evaluation of drugs for listing since 1994 has been based on a cost
effectiveness model, which was a world first at the time.
In some cases based on PBAC advice, price /volume arrangements may be
applied (i.e. the price reduces as volume of usage increases allowing for the
fact that research and development costs will have been met once large
volumes have been sold).
The same pricing principles are applied to all PBS prescriptions. Under
brand premium arrangements, the Commonwealth reimburses pharmacists
based on the lowest priced brand. Under the therapeutic group premium
arrangements, which apply for some therapeutic groups of drugs,
reimbursement to the pharmacist is based on the lowest priced benefit within
the identified therapeutic groups. Reimbursements to the pharmacist are
managed by the HIC, which gathers data on these reimbursements 8.
The cost to the patient is determined by the patient’s health concession card
status. Currently some 79% of PBS costs are to concession cardholders
whose maximum co-payment is currently $3.50 per script. The general
maximum co-payment rate is $21.90. A safety net provision applies to high
users of medicines with the current threshold as $669.70 for general users
and $182.00 for concession cardholders. Because the Government has
increased access to concessional health cards (including self-funded retirees
subject to a generous income limit), public spending on the PBS has tended
to outstrip patient spending (on the co-payments).
Once patents expire, generic drug prices are renegotiated for PBS listing.
PHARM.APAC DHAC, 2001, pg 45
Department of Health &Aged Care, 2001, pp36
AMA - PBS Discussion paper prepared by Jennifer Thomson & Roger Kilham Feb 2002
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Cost effectiveness
In 1994, the PBS internationally pioneered the use of a model cost effectiveness for
the evaluation of all drugs being submitted for inclusion on the PBS. Despite such
an approach, no Australian studies are available measuring the influence of the PBS
on health outcomes. It is understood that what government is buying through it
National Medicines Policy and therefore the PBS should be improved health
outcomes at an acceptable price. Some studies in the US have measured
pharmaceutical formularies and their impact on health outcomes in Health
Maintenance Organisations. Similar studies must occur in Australia to inform
rational policy decisions regarding the PBS.
The cost effectiveness data and research made available to the PBAC in assisting it
with its recommendations on listing is not made available generally. Transparency in
these processes is needed to evaluate their effectiveness. There are some
concerns that many of the trials and research justifying PBAC decisions may not be
undertaken in a “real world” context. Post drug release research is also important in
ongoing review of drugs on the PBS.
In many instances, it is clear that pharmaceutical interventions are more cost
effective than some surgical interventions eg treatments in peptic ulceration. Death
rates for peptic ulcers have decreased markedly.9 Drug therapies have been critical
in control of progression of major disease states such as diabetes, cardiovascular
disease and mental health. Focus on such diseases within the National Health
Priorities and implementation of current strategies in these areas will inevitably lead
to further costs in the PBS. It is anticipated that 50% of diabetics are undiagnosed
and with the current strong policy to identify diabetes, then short to medium term
pressures on diabetic drugs will occur. However the enormous potential savings in
long term disease progression and complications are enormous and must be
recognised. It is not clear that integrated planning or policy development is occurring
across government. The likely cost implications on the PBS of the current National
Health Priorities are not being articulated.
Drivers for PBS growth
There are many possible drivers for PBS cost growth. Some might include:
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Increasing access to concession status eg 2001 budget Commonwealth Seniors’
Health Card entitlements.
New listings such as Celebrex and Zyban with a trend to more expensive listings.
Drug choice of new and more expensive drugs.
Leakage (Doctors prescribing of PBS drugs for other than approved conditions) is
probably increasing although there is little hard data available on this. It was
estimated that proton pump inhibitors should be used by less than 35,000; in fact
177,000 people are receiving such medication costing an extra $220 mill per
annum.10
As previously mentioned, these drugs are largely initiated by
specialists who are not receiving the benefit of NPS education.
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9
PHARM.APAC DHAC, 2001, loc. cit
Department of Health & Ageing, 2001, pg 5
10
AMA - PBS Discussion paper prepared by Jennifer Thomson & Roger Kilham Feb 2002
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Changing demographics of the population eg ageing population with the over 65
age group likely to double in the next fifty years. This group is the high user
group.
Disease patterns are constantly changing with demand for appropriate treatment
interventions likely to be affected. The numbers estimated to be depressed or
asthmatic in the population has increased. Disease prevalence and detection of
diabetes has trebled in the last 20 years. A number of government strategies are
in place around the National Health Priorities to increase identification and
effective treatment of such patients. This will inevitably impact on the PBS. Drug
trials on which decisions to list on the PBS are based, may not take into account
these other trends and strategies.
Marketing strategies of the industry are becoming more sophisticated and are
well resourced.
Other drivers have been mentioned previously and include the expansion of
effective drug therapies for many of the chronic diseases, increasing community
expectations around drug accessibility and the rise in the practice of defensive
medicine.
Prices paid for drugs
The prices paid for drugs in Australia have been low compared to other OECD
countries. Some of the increasing cost of the PBS can be attributed to a 1990s
policy of moving drug prices closer to world parity prices. Part of the logic for this
has been to sustain a viable Australian pharmaceutical industry. However, it is
unlikely that any Australian Government would ever meet drug company hopes for
prices. Pharmaceutical companies are far more profitable, on average, than
companies in the remainder of the economy. The rapid rate of technological change
may be one of the factors underpinning this profitability. In comparison with most
other industries, the drug companies have a much higher proportion of their output
protected by patent at any point in time. Most of the companies are large multinationals with considerable market power. In the USA, the companies enjoy very
significant political influence, which they wield to protect their position and their
profits. It is difficult for any one country to unilaterally influence the behaviour of drug
companies.
AMA endorsed principles relating to the PBS
The AMA has been concerned at the rising costs and the potential risks to doctors
and patients alike if the PBS is substantially changed by future government
interventions. As such the Federal Council at its meeting in July 2001 passed
several resolutions:
That Federal Council supports the principles of the Pharmaceutical Benefits Scheme
(PBS) to provide universal access to medicines for the public in an effective, efficient
and equitable manner.
That Federal Council urge that solutions to the funding crisis in the Pharmaceutical
Benefits Scheme (PBS) be urgently found with input from the Government, the
pharmaceutical manufacturers, the AMA and patients.
AMA - PBS Discussion paper prepared by Jennifer Thomson & Roger Kilham Feb 2002
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That Federal Council supports that the direction for such solutions include ensuring:
a) The independence of the Pharmaceutical Benefits Advisory Committee and
extending its role to incorporate a special pricing review subcommittee;
b) The transparency of the listing process;
c) Adopting evidence-based economic and clinical risk benefit review of already
listed drugs;
d) Improved prescribing decision support, patient information; and
e) Monitoring the marketing methods of the manufacturers.11
Current government concerns
The current growth in PBS expenditure is alarming government, with PBS growth of
259% over the last decade compared to the Medicare Benefits Schedule growth of
73%. These total change growth figures must be viewed in the light of the changes
from cash to accrual accounting by Government. Growth would be better expressed
as average annual real per capita growth rates to give a more realistic assessment
of the situation.
The PBS currently represents 15.4% of Commonwealth’s $27 billion annual health
expenditure (at $4 billion) and last year was the fastest growing area of health
budget, with a growth rate of 19% ($700 mill) in 2000/01, around half of that growth
being attributed to lipid lowering drugs ($100 mill), Celebrex ($160 mill) and Zyban
($65 mill).12 However, growth is not expected to continue at 19% p.a. The
underlying trend growth rate is more of the order of 10 to 11% pa. The Government
has budgeted on PBS spending increasing by 8.0% for 2001-02.
As mentioned, the trend growth is not unlike other equivalent countries and Australia
is still a relatively modest spender on pharmaceuticals. Canadians spent $12 billion
on prescription medicines in 2001, five times that spent in the mid 1980s.13
Physicians’ services and prescription drugs now generate equivalent total costs in
Canada, while the ratio is still at 2:1 in Australia.
The average cost per script is growing. In last 10 years in Australia, the cost per
script has grown by 126% and volume of scripts by 54%. In 2000/1 volumes of
scripts grew by 7% and cost per script by 12%.14 As in Canada the newer drugs are
more expensive. In 1999 in Canada 60 % of prescriptions were for products of over
15 years of age, with the costs for these scripts only at 22% of the total. It would be
worth exploring the relative use of older, cheaper, effective drugs in Australia.
A systems approach
Analysis of the cost increases in the PBS requires a system approach with the
understanding that intervention or change at any point in the system will affect the
11
AMA Federal Council. 2001
Department of Health & Ageing, 2001, pg 2
13
Morgan , 2001, pg 1508
14
Department of Health & Ageing, 2001, pg 4
12
AMA - PBS Discussion paper prepared by Jennifer Thomson & Roger Kilham Feb 2002
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system as a whole and often in ways that are not anticipated. Many have been
advocating a more “holistic” approach to health care policy over the years. 15
However it is clear that no one intervention will achieve the cost containment.
Evidence of effective strategies to date must be considered in the choice of
interventions.
Future approach to the PBS
1.
The system
The AMA strongly supports the PBS and is concerned that any future strategies for
development of the PBS be strategies that enhance the strengths of the system,
rather than change the current system.
There is potential danger in the AMA aligning itself too closely with Government
policy focussed mainly on control of PBS spending. Given the technological
developments, the best health outcomes may indeed require pharmaceutical
spending to increase as a proportion of total health spending.
If new
pharmaceuticals can achieve the results they aim to achieve, then doctors will want
their patients to have access to them, and will expect their representative
organisations to emphasise health outcomes and quality care.
The AMA reiterates that it supports the principles of the Pharmaceutical
Benefits Scheme (PBS) to provide universal access to medicines for the public
in an effective, efficient and equitable manner. As such the AMA would
support future approaches that strengthen the current checks and balances in
the system rather than any major change.
2.
Research and Evaluation
Decisions around health policy should be based on best possible research and
evaluation. There is a gap in Australian based research on PBS impact on health
outcomes. There are also limited data sources for effective monitoring and
evaluation of the PBS with sources such as HIC data consisting of billing data and
not linked to disease states.
The AMA recommends that:
 The Government properly fund Australian based research on PBS impact
on health outcomes; and
 Development of data sources for effective monitoring and evaluation of the
PBS.
3.
Integrated health policy
It is important in health policy development to take a systematic approach to change.
The National Health Priorities (NHP) have set a framework for the development of
15
Leeder and McAuley, 2000, pg 50
AMA - PBS Discussion paper prepared by Jennifer Thomson & Roger Kilham Feb 2002
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health policy in Australia. It is not clear that the impact of the strategies on the
National Medicines Policy and particularly the PBS has been considered.
The AMA recommends that a systems based approach be taken to health
policy development and that the National Medicines Policy including the PBS
be linked to other health policy eg the National Health Priorities.
4.
PBAC processes
The transparency of the PBAC processes has remained of some concerns to
stakeholders. This has included issues such as objective membership of the
Committee, transparency of the process where reasons for decisions cannot be
released and where important evidence-based information is not made available to
prescribers or users prior to drug release.
The AMA supports increasing the independence and transparency of the drug
listing process and improving the supply of evidence based information to
prescribers and consumers in a timely fashion at the point of drug release.
5.
Drug listing review
The PBS introduced a world leading and innovative process of drug listing in 1994
when it required all new drugs to be evaluated against a cost effectiveness
framework. Drugs listed prior to 1994 have not undergone such evaluation. There
may be a case for looking at some of the pre-1994 drugs using a cost effectiveness
evaluation model. The evidence-based medicine approach that underpins the QUM
strategies has already resulted in significant changes in prescribing practice. There
are clear risks in withdrawing well-used drugs for industry, health professionals and
consumers. These probably represent the majority of prescription drugs. Canadian
figures in 1999 indicated that 60% of scripts were for drugs at least 15 years old.16
The AMA supports the adoption of an evidence based economic and clinical
risk benefit review of listed drugs that have not yet undergone such review.
6.
Quality Use of Medicines
The QUM approach has been important in setting the framework for evidence-based
prescribing in Australia. Much of the information available to doctors is produced
and distributed by drug companies who obviously have a vested interest in
marketing their products and spend large resources on such promotion to the public
indirectly as well as to the prescriber very directly. As an alternative, the NPS has
provided an objective evidence-based source of information to prescribers (mostly
general practitioners) and increasingly to pharmacists and consumers.
It is clear that all participants have some responsibility in responsible prescribing.
The doctor cannot become the defacto regulator of the system through an increasing
process of authority prescription restrictions. Such restrictions require increased
consultation time with patients and increased administration time for the practice.
16
Morgan, loc. cit
AMA - PBS Discussion paper prepared by Jennifer Thomson & Roger Kilham Feb 2002
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The AMA supports improved prescribing decision support and patient
information. The principles of evidence-based medicine must apply to such
strategies and increased resourcing must be provided to ensure timely and
effective delivery of evidence to the point of clinical decision making for both
general practitioners and specialists.
The AMA recommends monitoring the marketing methods of manufacturers to
both the public and health professionals.
The AMA does not support increasing the number of new drugs being listed as
authority prescriptions where the prescriber is being used as the primary
mechanism for cost containment of that new drug. The responsibility for
evidence-based usage of drugs rests with all stakeholders including
government, the industry, health professionals and the consumer.
7.
Signals for consumers
Patient co-payments are typically set higher for pharmaceuticals than they are for
doctor consultations. Australia is by no means alone in using this strategy, although
it may go a bit further than other comparable countries (Canada and the UK aside) in
attempting to avoid price signals for GP visits. However, patient co-payments have
little use as a tool for managing demand because the demand for prescription drugs
is referred demand (driven by the actions and the authority of the doctor). Therefore,
the main purpose in applying patient co-payments is to share the financial risk of the
PBS with householders.
The only change of any significance in Australia’s co-payment policy in recent years
has been the inclusion of many self-funded retirees in the concessional part of the
PBS scheme (the Seniors Health card). This is subject to a generous income limit
and, as noted earlier, it has resulted in the Federal Government increasing its share
of the cost of the PBS. Even without any change in policy, the Federal
Government’s share was increasing because of growing income inequality in
Australia. Over time a higher proportion of the population has qualified for some sort
of benefit, and therefore for a health care card of one sort or another. In this context,
the PBS is not just a scheme for providing access to pharmaceuticals. It is also part
of the overall social policy framework, and is used to redistribute income within the
community.
Aggregate demand for pharmaceuticals may be little affected by higher patient price
signals. In the USA, for example, the sharing of the financial burden is radically
different to that in Australia:
Sharing the Financial Burden of Prescription Drugs
USA versus Australia (percentage of funding)
USA (1)
Australia (2)
Patient out-of-pocket
32%
16%
Private health insurers (3)
46%
0%
Government subsidies
22%
84%
Total
Footnotes:
AMA - PBS Discussion paper prepared by Jennifer Thomson & Roger Kilham Feb 2002
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(1) Prescription drugs. Source: CMS Health Expenditure database.
(2) Benefit-paid pharmaceuticals. Source: AIHW Health Spending Bulletins.
(3) Private health insurers in Australia do pay modest benefits on drugs, which do not attract a PBS
benefit.
However, higher price signals will have a deleterious effect on those with very low
incomes. There is ample evidence from the USA that access to pharmaceuticals is
very uneven, with some groups having little access which other groups are very high
users. Ultimately this is a social policy issue and is about equitable access to quality
health care.
Labelling of dispensed medicines with information about their real cost has been
trialed in some European countries. Effects of such labelling included consumers
demanding the higher cost drugs, as these were perceived as “better” drugs. Clearly
any mechanisms for sending signals to consumers need careful consideration.
The AMA recommends exploring mechanisms for increasing direct consumer
knowledge and responsibility for costs of new medicines.
Bibliography
AMA Federal Council, 2001. Minutes of AMA Federal Council meeting, 27-28 July
2001, Australian Medical Association, Canberra
Australian National Audit Office, 1997. Pharmaceutical Benefits Scheme - Auditor
General Performance Audit Report No 12, 1997-8. ANAO, Canberra
Department of Health & Ageing, 2001. APAC Speaking Notes on the PBS, APAC 23
Nov 2001, DH&A., Canberra
Department of Health & Aged Care, 2000. Australian Pharmaceutical Advisory
Council 2000 –2002, Ausinfo, Canberra
Department of Health & Aged Care, 2001. Schedule of Pharmaceutical Benefits
August 2001, Ausinfo, Canberra
Leeder, S. and McAuley, I., 2000.The future of Medicare and health service
financing. MJA, July 3 Vol 173, No 1, pp. 48-51
Morgan, S., 2001. Statistics and drug utilization: Are prescribing rates really that
high? CMAJ, Nov 27, 2001; 165 (11) pp. 1507-8
National Prescribing Service., 2001. NPS news, 19 December 2001, Surrey Hills,
NSW
PHARM & APAC, DHAC, 2001. Quality Use of Medicines: A Decade Of Research,
Development and Service Activity 1991 – 2001. Quality Use of Medicines and
Pharmacy Research Centre, University of South Australia, Adelaide
Robertson, J et al., 2001. The impact of specialists on prescribing by general
practitioners, MJA, Vol 175 No 8, pp. 407-411
AMA - PBS Discussion paper prepared by Jennifer Thomson & Roger Kilham Feb 2002
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Resolutions from Australian Medical Association Federal Council Feb 02
Pharmaceutical Benefits Scheme
1. The AMA reiterates that it supports the principles of the Pharmaceutical Benefits
Scheme (PBS) to provide universal access to medicines for the public in an
effective, efficient and equitable manner. As such the AMA would support future
approaches that strengthen the current checks and balances in the system rather
than any major change.
2. The AMA supports the right of all Australians to be prescribed quality medications
in a timely and user friendly manner.
3. The AMA recommends that the Government properly fund Australian based
research on PBS impact on health outcomes and the development of data
sources for effective monitoring and evaluation of the PBS.
4. The AMA recommends that a systems based approach be taken to health policy
development and that the National Medicines Policy including the PBS be linked
to other health policy eg the National Health Priorities.
5. That AMA recognises the Government’s ability to control the cost of the PBS, but
any changes should be on the basis of scientific evidence and “ proper” economic
modeling of health.
6. The AMA supports increasing the independence and transparency of the drug
listing process and improving the supply of evidence based information to
prescribers and consumers in a timely fashion at the point of drug release.
7. The AMA supports the adoption of evidence based economic and clinical risk
benefit review of listed drugs that have not yet undergone such review.
8. The AMA supports improved prescribing decision support and patient
information. The principles of evidence-based medicine must apply to such
strategies and increased resourcing must be provided to ensure timely and
effective delivery of evidence to the point of clinical decision making for both
general practitioners and specialists.
9. The AMA recommends monitoring the marketing methods of manufacturers to
both the public and health professionals.
10. The AMA does not support increasing the number of new drugs being listed as
authority prescriptions where the prescriber is being used as the primary
mechanism for cost containment of that new drug. The responsibility for
evidence-based usage of drugs rests with all stakeholders including government,
the industry, health professionals and the consumer.
11. The AMA rejects any suggestion that doctors are deliberately prescribing in any
way other than in their patient’s best interest.
12. The AMA recommends exploring mechanisms for increasing direct consumer
knowledge and responsibility for costs of new medicines.
13. The AMA urges Federal Council to mount a campaign, in collaboration with the
consumer health organisations, to oppose bureaucratic, restrictive, prescribing
regulations.