Menopause hormonal treatments to retain PBS listing

Morgan Liotta

20/09/2021 3:31:19 PM

While GPs have welcomed the news, there are concerns a subsequent price increase will represent further gaps in access to care.

GP talking to a female patient.
The flexibility afforded by hormone transdermal patches helps improve access to treatment for women.

The Pharmaceutical Benefits Scheme (PBS) and Department of Health have reached an agreement with pharmaceutical company Sandoz to retain menopause treatments on the PBS with an updated price to ‘support continuous and sustainable supply of the products’.
This agreement follows extensive lobbying from the Australasian Menopause Society (AMS), RANZCOG and the Endocrine Society of Australia, including a letter to Health Minister Greg Hunt in May, opposing the proposed delisting of the products from 1 October.
The hormone transdermal patches containing estradiol, or estradiol with norethisterone are sold as Estradot, Estalis Continuous and Estalis Sequi, and offer important treatment options for menopausal women.
AMS President-elect Dr Karen Magraith welcomed the news.
‘The combined oestrogen-progestogen patch is the only combined transdermal product available in Australia, and it is vital that this option remain available on the PBS,’ she told newsGP.
‘It is an especially convenient and accessible option for women because it only requires one prescription and the use of one product. The patch provides an option for transdermal oestrogen that is well-accepted by patients in a range of dosages.
‘In addition, transdermal oestrogen does not confer the risk of venous thromboembolism that oral oestrogen can, so is a suitable option for many women.’
Dr Magraith said the flexibility the product offers is a significant benefit and can help improve access to treatment.
‘Access to treatment is clearly an important issue for many patients, and there is increasing recognition of the importance of continuing availability of a range of treatment options depending on the individual circumstances of the patient,’ she said.

‘[For example,] the oestrogen patches are also used by some transgender patients and continuing access is important for them.’
GP and women’s health advocate Associate Professor Magdalena Simonis told newsGP that continuous and sustainable access to the treatments is ‘a good thing and very welcome’.
‘It has been a very trying time for women trying to source substitute MHRT [menopausal hormone replacement therapy] during COVID-19 and into this year, due to supply shortages,’ she said.
‘The switch to other products has not always suited women and the options have in some situations caused more overall expense to women, as they have had to stop and try something different a few times to get close to the preferred outcomes.’
However, while PBS access to these MHRT products will continue, supplier Sandoz has stated that the price will increase from 1 October to reflect the ‘increasing cost to manufacture these medicines’.
Both GPs are concerned the price increase impact women, particularly those on low incomes, and say it further highlights healthcare access inequality in Australia.
‘The price increase will be prohibitive for low-income women who do not receive healthcare card benefits, which given the gender pay gap has increased by 14% this last financial year, is another blow,’ Dr Simonis said. 
‘It is unfortunate that in the overall scheme of things, 10% of menopausal women require MHRT, and the overall cost to the PBS if there were no price increase, would be relatively low.’
Dr Magraith previously warned of the implications of a price increase, which she now says is ‘unfortunate’ and will be noticed by non-concessional patients.
‘Hormone therapy, when used appropriately, is not an “optional” or “lifestyle” treatment, as is sometimes assumed, and it is important that patients are able to afford the treatment that is prescribed for them,’ she said.
‘It’s especially critical for women with early menopause or premature ovarian insufficiency to have appropriate treatment.
‘For some women the optimal treatment may be a transdermal oestrogen patch along with micronised progesterone capsules, which are not PBS listed. When taken together the treatment can be prohibitively expensive for some women. 
‘The AMS will be following the issue with interest.’
It is not yet known what the proposed price increase will be, but Sandoz’s previous application to the Pharmaceutical Benefits Advisory Committee ranged from $7.35 to $24 per script on the PBS, with private prices to rise to $30–40 per month.
Dr Simonis continues to raise the issue of gender inequalities as well as the financial barriers when it comes to accessing care.

‘[For women,] the symptoms of urogenital syndrome include uncomfortable or painful sexual intercourse and can also affect the bladder resulting in cystitis-like symptoms, or even recurrent UTIs in older women,' she said.  
‘These conditions affect a large proportion of women in perimenopause and menopause and for many, the only relief is MHRT.'
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