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Behind the scenes at the PBAC


Matt Woodley


11/06/2019 2:26:41 PM

Outgoing RACGP representative Rashmi Sharma pulls back the curtain after 10 years on the Pharmaceutical Benefits Advisory Committee.

Rashmi Sharma
Clinical Associate Professor Rashmi Sharma believes GPs often provide the PBAC with a perspective that other specialists may not.

One of the most influential health bodies in the Australian health landscape, the Pharmaceutical Benefits Advisory Committee (PBAC) meets three times a year to recommend new medicines for listing on the Pharmaceutical Benefits Scheme (PBS).
 
Many aspects of the PBAC’s inner workings are confidential in nature, but Associate Professor Sharma was able to share some of her experiences with newsGP and explain why she found the work so rewarding.
 
‘I always considered it to be my brain gym, because you’re looking at very, very complex and detailed clinical evidence-based submissions,’ she said.
 
‘Certainly you need to be prepared for a lot of hard work, as well as having to probably change your mindset from sitting in general practice and performing “the art of medicine”, to looking at facts and figures, statistics and trials, and all those other things that as GPs we don’t necessarily encounter every day.’
 
Determining which medicines to subsidise means the PBAC needs to consider clinical effectiveness and the conditions for which the medicine is registered for use in Australia, as well as its safety and cost-effectiveness compared with other treatments.
 
Due to the unique perspective they provide, Associate Professor Sharma believes GPs are vital to the proper functioning of the committee, a view she said is shared by all PBAC members.
 
‘As GPs, we will often see the consumer perspective and clinical need that a specialist in the hospital may not,’ she said.
 
‘We’re the bulk of prescribers, so that’s obviously a very important and valid viewpoint as we can provide feedback regarding whether or not there are barriers to accessing certain medications and how we expect the utilisation of the medication will be, because government needs that to project budgets and forecast expenditure.
 
‘It was also satisfying to be able to see that you may have made a recommendation that led to the committee suggesting that this medicine is worth subsidising, which subsequently made a huge difference to the Australian population.’
 
Aside from satisfaction derived from helping potentially millions more Australians than she otherwise would have been able to from her suburban practice, Associate Professor Sharma also believes her time on the PBAC had made her a better GP for her regular patients.
 
‘It has certainly improved my quality use of medicine … when you [have to] analyse prescribing you can see that there are areas where there are room for improvements that you can incorporate in your own personal prescribing,’ she said.
 
‘For example, the use of combination puffers in children – you think twice when you remember “well, it’s not actually indicated for this group of people” and a lot of the time the reason for that is the clinical evidence.’
 
Time on the committee also helped Associate Professor Sharma see the bigger picture in a way that may not always be apparent from a consulting room.
 
‘Despite dealing with budgets of billions of dollars, you realise it is still finite and there’s a lot we need to do with that money. So from a general practice point of view, we’ve all got a little bit to contribute in making sure that that budget is sustainable,’ she said.
 
‘We need to think about that when we order tests or actually prescribe, in terms of being responsible. Being on the committee and looking at opportunity costs has really opened my eyes to that – if you fund this [treatment or medication] you can’t fund that, you really have to prioritise.’
 
Despite finding the decade she spent on the PBAC incredibly rewarding, Associate Professor Sharma believes it’s time to ‘refresh’ and has encouraged any interested GPs to apply.
 
‘After 10 years another set of eyes is good and also the workload is considerable. So, for me, it’s time to go and do other things,’ she said.
 
‘I’m not sitting in a university – I’m pretty much a typical suburban GP practice principal who managed to contribute to policy, so I would just say to anyone give it a go because you never know.’



PBAC PBS Pharmaceutical Benefits Advisory Committee Pharmaceutical Benefits Scheme



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