Implementation of 60 day PBS scripts

As of 1 September the first set of eligible PBS medicines will be available for 60 day instead of 30 day scripts. This means that for those medicines, if your doctor agrees, you will only need to get those scripts from your doctor once a year (instead of every six months) and you will only need to go to the pharmacy six times a year instead of twelve and pay half the price per year.

Other medicines will be moved to the scheme at later times and some will remain unchanged.

The official version from the Dept of Health is here. This explains which medicines are available, when and how.

One point covered is the savings from the dispensing fees no longer required will be reinvested in community pharmaceutical services including additional subsidies for rural and remote pharmacies (something I was concerned about) and furthering immunisation and addressing opioid dependence.

There are rumblings that the Opposition, Greens and crossbench might vote it down in the senate as they are being lobbied by the Pharmacy Guild who are in a panic that this will be the end of the world. It seems unlikely to me the bill will be successfully opposed but we will have to wait and see what kind of argy-bargy can be cooked up.

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I don’t understand the half the price per year bit.

You would still buy the same amount of medicine per year.

With fewer doctor appointments per year, maybe savings there if the GP didn’t bulk-bill.

Maybe savings on chemist dispensing fees, which is part of what the chemists are complaining about. But I thought the Gov had agreed to increase the dispensing fee as part of this change.

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I agree with @Gregr. The impact on the pharmaceutical side of things should be negligible if the dispensing fees are increased to offset the change.

However, the greater impact would be that there is reduced traffic through a pharmacy. Less traffic means less compulsive buyers or being able to onsell non-pharmaceutical products. Less sales of non-pharmaceutical products could impact on the pharmacies bottom line. It could be seen as a positive as many non-pharmaceutical products have no proven efficacy which could save the consumer buying ‘dud’ products.

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I agree. I cannot find the budget costings or any source documents but the press, Minister’s press releases and the Dept of health say the same, that you will pay one copayment per script and get twice the product.

The releases say 1.2 billion will be saved on unnecessary scripts, the user will be saved 1.6 billion, both over 4 years. Also the 1.2 b saved will be reinvested not returned to coffers. However it is expected that Medicare will also have savings due to doctors billing for fewer scripts. So whether the whole thing is expected to be neutral or extra cash will be chipped in I do not know.

If anyone can find the detail and answer the questions I would be much obliged. Who likes dumpster diving in budget papers?

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A substantial discussion around pharmacy practices and more recently the 60 day 12 month prescription proposal can be found in the following topic. I’ve linked to where that particular discussion commences.

At risk of going over the same ground or is there more to add?

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What bill would that be? To be opposed?

Sometimes the best response is the answer.

The RACGP has joined patient and healthcare groups to urge opposition and crossbench politicians in the Senate to avoid attempting to block a move to 60-day dispensing.
……
In a joint press release, leaders from the AMA, Asthma Australia, Lung Foundation Australia, Breast Cancer Network Australia and the RACGP said such a move would have an adverse impact on patient care.

It may come to nothing, depending on political will, and the arguments being put by the Pharmacy Guild.

RACGP President Dr Nicole Higgins said she would like to see clarity from politicians on the issue and called upon Coalition leader Peter Dutton as well as the Greens Party to rule out a veto attempt.
‘Sixty-day dispensing is in patients’ best interests,’ she said.
‘It will save around six million people money and time, and free up GP consults for other patients.’

Does it need legislation?

While the dispensing policy does not need legislation, it is known as a disallowable instrument. That gives senators 15 sitting days of Parliament to veto the change after it is tabled to Parliament, which was due to take place this week.

RACGP - Senators pushed to hold firm on 60-day dispensing

What’s a disallowance motion?
No. 19 - Disallowance – Parliament of Australia

Note:
Note I’m a beneficiary of the proposed rule change with 3 regular meds covered by stage one of the rule change and a 4th med for the second stage. The RACGP assessment is supportive if asking why.

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As I thought. There is no legislation involved to be passed by Parliament. It is a regulation change.

Sure a disallowance motion could be proposed by any member of either house, but have we seen one? No. Those are rarely used, and mostly used when the Gov of the day tries to make a change by regulation that the majority of the Senate opposes and would fail by legislation.

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Coalition will seek to stop Labor’s 60-day medicine policy in the Senate

So the argy-bargy commences.

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The cost of the medicines itself will obviously be the same. So Big Pharma still has the same revenue.

The revenue that goes to the pharmacy (for filling the prescription) and to the doctor (for writing the prescription) will be halved (for the specific medicines covered by this change).

So there are prima facie savings for the taxpayer and for the consumer but ultimately those savings come at the cost of reduced revenue for someone else. This isn’t really much different from any government “efficiency dividend”. Someone always loses.

(Heck, even if the government did something “good” like actually improving the population’s health, there would still be losers.)

The final picture depends on what happens with the savings in respect of the above-mentioned “reinvestment” etc.

Will those savings actually just go straight into consolidated revenue i.e. affect only the bottom line?

Will what happens with the savings be policed at all? i.e. will there be any transparency or accountability regarding the above-mentioned claims about “reinvestment” etc.?

Even though the disallowance motion is probably doomed to fail, it makes sense for the Coalition to look after the interests of its supporters (doctors, pharmacists).

Well, indeed, but maybe it would be better if ‘dud’ products were just banned. :wink:

That would apply to supermarkets, as well as pharmacies, as well as any other retailer that wants to sell ‘dud’ products.

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Coalition withdraws attempt to unwind half-price medication scheme, asking for government to delay

A day is such a long time in politics.

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Nearly snorted my morning cup of of coffee out my nose when I saw that.

Yes, they backed off on their idle threat of a disallowance motion. Obviously some saner advisors to the coalition told them that there was buckleys chance of the motion succeeding in the Senate, and it would not be a good look to oppose a measure that would benefit millions of voters.

Sometimes the Opposition take their job description too literally.

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I’m unconvinced this is actually going to save many people money. It costs less to go to a pharmacist for vaccinations and sick certificates than it does to go to a GP. Many pharmacists also provide health checks (eg heart, diabetes) and provide sensible advice re commonplace ailments.

What I’d really like to see is a cost-benefit analysis of the move that considers true costs to all Australians if pharmacy services are compromised.

Would you be willing to develop that model, including documenting all the potential variables, their accuracy, and the standard deviation?

I don’t expect that can be easily done, but I suspect on the balance of probability the largest constituency has been modeled, identified and served. Can I query why you seem sceptical? The pharmacy guild is complaining but have they provided their own modelling?

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The up front savings are:

  • half price for specified drugs (the link above gives individual and family savings for a number of situations)
  • half as many trips to the doctor for scripts for those drugs
  • half as many pharmacists trips for them also.

The published saving in user savings is 1.6 billion dollars over 4 years.

What would be the costs that are more than that?

I was quite concerned that small pharmacies in rural and remote areas that the residents depend on, that have much smaller turnover, may not be viable. The above link also tells us that these businesses are subsidised now and when this change is implemented their subsidy will double. I hardly think the government is going to allow them to go under and leave some communities with no service, I expect the situation to be watched pretty closely.

In your view in what way would pharmacy services be compromised?

If you want to see more detail this change in rules was brought about by an expert recommendation by the Pharmaceutical Benefits Advisory Committee which is available to the public.

A further consideration is that as the population ages more people will be on long term medication in the target categories and so the scheme will become more beneficial over time.

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A huge number of pharmacies around us (not the big warehouse brands) have in the last 12-18 months reduced their floor area by half or less so a LOT less compulsive buying, nothing to see here…

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You seem to have some reason in mind that some pharmacies are reducing in area what is it? Is it related to 60 day scripts?

Without knowing the methodology used by the Government to calculate the savings figure, none of us are in a position to know the answer to this question.

The game has three players with the Government said to paying the same amount, the pharmacies said to be losing $1.6 billion and the public said to be saving $1.6 billion.

Looking at the above figures, it seems like a big win for the six million members of the public. However, even if the figures are true, they don’t give a real big win. The average amount equates to an benefit of $66.67 per year, which is less than 20 cents per day.

When you add the fact that most of the six million will be getting lower than the average, there won’t be a lot of the population receiving a significant benefit. Those who do so are unlikely to be the most needy, who already pay a lower rate for medicines and have a lower safety net threshold.

If your point about pharmacies cutting back on staff and services becomes reality, this will mean that some “winners” from the changes, along with some of the 77% of the population who don’t directly benefit, will become overall losers.

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The figure for savings on scripts I have seen is 1.2 billion. This is where the numbers get mystical as one loss doesn’t match the other gain. As the savings on scripts are being redeployed there must be new money coming in. But just how much I can’t find out, I cannot see any detail in the budget papers.

Those who spend more as they have a lot of target drugs will save much more, averages do not tell the whole story. Also this doesn’t tell us anything about why it is or isn’t going to save people much as it seems DPom has other factors in mind.

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This problem generally arises when we have to rely on the marketing spin from Government for information.

My understanding is that the Government pays the pharmacies a certain amount for each script filled. Under the changes, the total amount will be roughly halved for the relevant medicines. The Government savings from this change will, in some way, be given back to community pharmacies. I don’t think the pharmacies will be compensated for any $1.2billion or $1.6 billion reduction in amounts paid directly by customers.

The rules of maths are helpful here. As the average amount is below the halfway point between the highest and lowest values, the majority of the target population must be receiving either the average amount or less. Also the further away the average is from the mid point, the higher the percentage of people who will be receiving the average amount or less.

The above tells us that more than three million people will be saving $66.67 or less per year, or $50 or less per year if the $1.6 billion figure is replaced with $1.2 billion.

The will be a small percentage of the population who will save a lot more than the average e.g. someone saving $180 per year for each of many eligible medicines. For every person in that category there will be many more saving nothing or close to nothing.