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Doubts over Guild push to reduce medicine co-payment


Anastasia Tsirtsakis


11/04/2023 4:53:30 PM

The RACGP’s President says the initiative, which will cost taxpayers more than $900 million over four years, will do little to reduce costs for patients and taxpayers.

A patient handing a pharmacist a prescription.
The Pharmacy Guild’s proposal would see patients pay a co-payment of almost $40 per month compared to $30 every two months if dispensing laws are changed.

With the Federal Government’s May Budget due to be handed down in just under a month, advocacy to reduce the burden on both the health system, as well as the cost-of-living crisis for Australians, has intensified.
 
In a bid to cut the cost of medicines for patients, the RACGP has strongly been advocating for medicine dispensing limits to be increased from 30 to 60 days.
 
Based on a 2018 recommendation from the Pharmaceutical Benefits Advisory Committee (PBAC), if endorsed, the proposal would mean patients could access two months’ worth of their medication at the one time – reducing the cost and number of pharmacy visits for patients, while freeing up doctor’s time.
 
However, the Pharmacy Guild of Australia has pushed back, claiming the proposal could worsen any existing medicine shortage by putting further pressure on supplies.
 
Instead, the lobby group has relaunched its Affordable Medicines Now campaign, calling for the co-payment on medicines listed under the PBS to be reduced from $30 to $19.
 
To help garner support, Guild President Professor Trent Twomey has written to Federal Health and Aged Care Minister Mark Butler and other MPs, in which he references the group’s own (unreleased) modelling that the move would ‘positively affect’ five times as many scripts as increasing the dispensing rules from 30 to 60 days, Nine Newspapers have reported.
 
The proposal comes with a heavy price tag, however, costing taxpayers an estimated $920 million over four years.
 
In contrast, the RACGP’s proposal to up dispensing quantities for more than 140 medications would halve dispensing fees, potentially saving the health budget more than $800 million each year.   
 
RACGP President Dr Nicole Higgins told newsGP that the college’s solution is a win for all – reducing the cost for both the patient and the taxpayer, while increasing access.
 
‘The Pharmacy Guild’s solution by reducing the co-payment means that it’s going to cost taxpayers an extra $920 million over four years,’ she said.
 
‘What they are proposing is there to protect their profits versus supporting the patient.’
 
The medicine co-payment was only recently reduced by the Federal Government, which saw it cut from $42.50 to $30 as of 1 January 2023.
 
Health economist Dr Stephen Duckett has indicated that reducing the co-payment even further is unnecessary, and that the RACGP’s recommendation would do more to reduce costs for patients.
 
‘Paying $30 once is better than paying $19 by going to the pharmacist twice,’ he told Nine newspapers. ‘It benefits concession card holders as well, who are on the [$7.30 rate].
 
‘The only people who lose out are the pharmacy owners, who are – surprise, surprise – putting up an alternative model that keeps people coming back to them and paying each time.’
 
Meanwhile, if the Guild’s proposal is endorsed, a further reduction to the co-payment could also have consequences for discount pharmacies, as they would forego Government subsidies on all medicines above the threshold that are discounted by more than $1 under the co-payment.
 
As such, Dr Higgins says that further reducing the co-payment could result in increased costs for some patients.
 
‘It will actually limit the ability of pharmacies to discount the medications. Perversely, it’s going to cost patients more for their medication,’ she said.
 
Aside from potentially contributing to a medicines shortage, the Guild has argued that 60-day dispensing presents safety concerns.
 
‘Doubling the quantity of medications in circulation may also facilitate inappropriate and harmful use,’ Professor Trent Twomey wrote to Federal MPs, according to Nine Newspapers.
 
‘At a time when the [Therapeutic Goods Administration] is reducing the pack size of paracetamol, it is incongruent to increase the surplus quantity of prescription medication in the community.’
 
However, Dr Higgins says the ‘risk of harm is low’, as the college’s proposal, if endorsed, will only apply to medications assessed as safe for extended dispensing by the PBAC.
 
‘The medications that we’re supporting for bigger pack sizes are for stable, chronic medical conditions that patients are on long term – it is not across the board,’ she said.
 
‘And how pharmacies manage their medications is a stock control issue – that is not an argument against improving access and reducing costs for patients.
 
‘Increasing dispensing to two months will be a significant advantage for our rural patients, especially for those who have to travel into town to pick up scripts. It also reduces the risk of people running out of medications every month and increases compliance and continuity.’
 
In 2020–21, more than half a million Australians delayed or did not have access to their medication due to cost, with those who have chronic conditions spending between an average of $200–$600 on healthcare each year.
 
A newsGP poll last month found strong support from GPs for the college’s proposal, with 85% of the 1074 respondents backing the move to increase dispensing limits.
 
With health system reform high on the Government’s agenda, Dr Higgins says it is vital for any advocacy to take a whole system approach.
 
‘The Guild’s proposal is opaque; it’s actually going to cost patients more,’ she said.
 
‘Whereas the RACGP proposal is going to save almost $50 a year per medication, which is a significant saving to patients.
 
‘General practice is being proactive in being part of a solution for whole of health system reform and we’re calling on the Pharmacy Guild to do the same.’
 
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Dr Philip Ian Dawson   13/04/2023 12:13:48 PM

Dispensing's primary purpose is patient health. This includes affordability and convenience which both improve compliance. The idea of monthly pharmacy visits and copayments as a "price signal" and disincentive to reduce consumption both have the effect of reducing compliance. We need a nuanced approach. On the one hand we want to reduce consumption of discretionary items like benzodiazepines (except for epilepsy) and narcotics(except for metastatic cancer). On the other hand we want to improve compliance for chronic diseases like Diabetes, Epilepsy and Cardiovascular diseases. So keep or increase a copayment for discretionary items, and eliminate it for chronic disease medications! Also whay not 3 months of medications for stable diabetics? Alrady those on Thyroxine get 6 months of medications in a packet, and some epileptic medications get more than a month eg valproate.