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Expanded PBS eligibility for heart failure and migraine medications


Alisha Dorrigan


30/10/2023 3:48:57 PM

More than 100,000 combined patients are expected to benefit from the changes, which will take effect from 1 November.

Doctor using stethoscope to treat patient.
PBS eligibility criteria has been expanded for heart failure and migraine medications.

PBS eligibility criteria for two medications aimed at patients who suffer from heart failure or episodic migraines are set to expand from next month, Federal Health and Aged Care Minister Mark Butler has announced.
 
Empagliflozin (sold as Jardiance), a sodium-glucose co-transporter 2 (SGLT2) inhibitor, is currently PBS listed for eligible patients with type 2 diabetes or those with heart failure, but only if they have been diagnosed as having a reduced ejection fraction.
 
However, from November, the PBS criteria will expand to include patients with heart failure with a preserved ejection fraction, defined as a left ventricular ejection fraction of more than 40%. The Department of Health and Aged Care is predicting 98,000 people will save approximately $300 per year as a result.
 
Academic and GP Associate Professor Ralph Audehm says therapeutic options for this patient cohort have been limited and that the PBS update will make a difference to the lives of people living with the condition.
 
‘It is great to see new medications that have a real impact on people with this dreadful disease. It improves outcomes as well as quality of life,’ he told newsGP.
 
‘Up to now there have been very few medications that demonstrated an impact in people with heart failure with preserved ejection fraction.’
 
Nearly half a million Australians are affected by heart failure, with empagliflozin reducing the risk of hospitalisation and death when combined with standard care measures.
 
Empagliflozin costs approximately $660 per year on a private prescription, and this cost will be reduced to just $30 per script, or less for concession card holders.
 
‘About 180 Australians are hospitalised every single day with symptomatic chronic heart failure and they are often repeated hospitalisations,’ Minister Butler said.
 
‘This listing will give patients access to a new treatment at a fraction of the cost they normally would have to pay.’
 
Meanwhile, it has also been announcement that migraine prophylaxis medication fremanezumab (sold as Ajovy) will be PBS listed for patients who suffer from treatment-resistant high frequency episodic migraines.
 
Fremanezumab, which must be initiated by a neurologist, is a monoclonal antibody that has been PBS listed for migraine prevention since 2021, but only for chronic migraine sufferers. Outside of this indication, patients could only access the medication privately at a cost estimated to be $6700 per year.
 
Under the new listing, fremanezumab will only costs $30 per prescription, or $7 for concession card holders, with around 6000 episodic migraine sufferers expected to be eligible for treatment. The medication is administered via subcutaneous injection at varying doses and intervals, ranging from monthly to three-monthly injections.
 
Episodic migraines cause severe headaches, nausea, vomiting and sensitivity to lights and sounds, all of which significantly impacts quality of life. As such, the PBS expansion has been welcomed by experts and patient advocates.
 
Neurologist Dr Elspeth Hutton from the Australia and New Zealand Headache Society thanked the Federal Government for recognising the debilitating nature of the condition.
 
‘Migraine is the leading cause of age-adjusted disability in Australia, and people with more frequent attacks have greater impacts on their ability to work, study and engage in family and recreational activities,’ she said.
 
‘This new listing for high-frequency episodic migraine will extend that chance for a better life to more Australians, and is enthusiastically welcomed by clinicians treating patients living with migraine.
 
‘Patients with [high-frequency episodic migraine] have a greater risk of progressing to chronic migraine, and like those with chronic migraine have a higher risks of developing comorbidities, such as medication overuse headache, poor mental health, obesity and cardiovascular illness.
 
‘Effective treatment for his group not only improves their lives now, but is vital to improve health over the lifespan.’
 
Patient advocate Carl Cinicinnato from Migraine and Headache Australia also welcomed the announcement and urged patients to seek treatment if they suffer from headaches.
 
‘This condition can profoundly affect an individual’s relationships, work, family life, overall wellbeing, and mental health,’ he said.
 
‘Although there’s no cure for migraines, appropriate treatment and management can alleviate symptoms for many.’
 
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