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The Role of ASM in Publishing Valid and Comprehensive Statistics

Question:

Discuss about the Australian Pharmaceutical Benefits Scheme and the Consumption of Medicines in Australia.

A publication is annually held in Australia regarding the statistics of medicine based on the production of its drug. The utilization of drug is also taken into account. ASM estimates the use of drugs by aggregate community by maintaining a data. The use of medicines that are prescribed by the doctors is necessary to able to intake in Australia. ASM represents Australian Statistics on Medicine, which maintains the procedure of publication of drugs. It is regulated by DUSC, which is mainly referred as Drug Utilization Sub-Committee, which is a part of the committee of pharmaceutical Advisory Benefits (Pearson et al., 2015).

It is essential to have drug utilization that is comprehensive, as they are needed for a large number of purposes. The purposes range from evaluation and targeting the initiative of quality use of medicines. The Pharmaceutical Industry also needs it as it helps the authorities of the financing and regulatory authorities. The main aim of ASM is to put valid and comprehensive statistics on the use of medicines into the public domain in Australia (Schaffer et al., 2016).


In order to enhance the healthy outcomes and the quality of medicines used in Australia, there is encouragement for International Collaboration about utilization of drugs. It can be found out in the publication of International data facilities available in Australia (Page et al., 2015).

PBS processing is done for providing a summary on prescriptions and maintaining its expenditure. There are availability of various charts and tables for the processing of cost, prescription volume and drug utilization. The Department of Government Human Resource in Australia helps in providing wide range of statistical information about various programs on Medicare (Currow & Sansom 2014). These programs include, MBS ( Medicare Benefits Schedule ), PBS ( Pharmaceutical Benefits Schedule ), RPBS ( Repatriation Pharmaceutical Benefits Scheme, AODR ( Australian Organ Donar Register ), AIR ( Australian Immunization Register) and PIP ( Practice Incentives Programme). Online report of Groups and BS Item use codes of PBS items, ATC classifications or patient categories.

The reports on the expenditure of the drugs that are highly specialized provides with a summary of the National expenditure. This expenditure on drugs is dispensed through Community Access, Private Hospitals or Public Hospitals. This data is quarterly reported in the present financial year along with the last two financial years as well (Thai et al., 2016).

Importance of Drug Utilization for Evaluation and Targeting the Initiative of Quality Use of Medicines


The Date of supplying tablets and the date of processing provides PSB the information about expenditure under section 85. The information is updated once in particular month, mainly around its second week. The ATC groups are also included in their scheme, including with the market share and PBS sales (Vitry & Roughead 2014).

The pharmaceutical expenditure has risen faster than the economy in Australia presently. It has leapt up to 1.1 % of gross domestic product from a mere 0.6%. The PBS expenditure has also rose from 5 to 8 percent on a routine basis. This growth is due party by the increased utilization and the increased price of dispensed medications (Mellish et al. 2015). The expenditure on health per capital of different nations for 12 years from 1995 to 2017 is given below:

Figure 1: Health expenditure per capita

(Source: OECD data, 2010)

The expenditure on PBS is a component that is growing at knots. It is growing around 15 to 20 % every year. If there is a continuity of its growth, then PBS will exceed on all hospitals in the recent years to come.

The listing of an item on PBS leads in commitment of Government expenditure significantly. Since 1993, a decision was started to check whether the drugs that were sold, actually were cost effective (Blanch et al. 2015). In 1987, the legalization on the analysis of cost-effectiveness was passed. Other details on submission listing, incorporating analysis of cost effectiveness was passed in 1990 and its definitive guidelines in the year 1992.

A drug can be listed in PBS only if it follows certain criteria. They are as follows:

  • Needed for significant medical treatment or its prevention, that is not covered. It can also be of not effective cost.
  • The drugs must be less toxic, more effective than the drug that is listed already for benefiting the same issue and is accepted for its cost effectiveness.
  • If the drug is more effective or shows symptoms of speedy recovery besides being safe.
  • The legality of drugs is taken into account by PBPA on the basis of certain steps listed below,
  • They look out on the cost effectiveness and criticality of drugs.
  • Researching on the prices of alternative brands of the same drug.
  • Comparing the price of drugs that are ranging in same group of therapeutic drugs.
  • Estimation of cost information provided by supplier.
  • Taking in account economies of scale, prescription volumes and all other factors like storage requirements, date expiration, special manufacturing requirements and product stability.
  • Checking the price of the particular drugs in other overseas countries which are relevant.

The PBS (Pharmaceutical Benefits Scheme) refers to a programme of the Australian Government. Here, the Government provides subsidized prescribed drugs to the residents of Australia. They also prescribe drugs for foreign visitors, covered by an agreement of Reciprocal Health Care. The total benefit that has been dispensed under the scheme is given below:

Figure 2: Community prescription dispensed

(Source: Created by Author)

In Australia, the cost of consumption of medicine is quite high when compared the other countries. In most cases, the Australians are paying four times greater value than that of their price in the international market for most of the drugs that are prescribed by the doctors. As a result of which nearly about 6% patients in Australia delays or avoid taking essential medicines due to their cost. According to the report published by Grattan Institute, it is stated that the cost of some medicines in Australia is 3.7 times more than their international prices that is unacceptably high. Prices of 19 Australian drugs were compared with that of the prices prevailing in UK, Canada and New Zealand and it was found that even after the 2nd round of cutting of the price of the drugs, it was still 3.7 times higher on an average than that of the best benchmark price. After assessing the reports it was found that the prices of the drugs in Australia was almost as twice as the same drugs costs in UK and 3.1 times higher than they actually costs in New Zealand. A fact that the government’s price disclosure policy was performing quite slowly was also added in the report.

Availability of Various Charts and Tables for the Processing of Drug Cost, Prescription Volume, and Drug Utilization


According to the report of an established health economist Stephen Duckett, many years had taken to achieve a policy that led to a considerable cut to the price of generic drugs in Australia. It is also included in the report that savings of government, tax payers and patient would be much more that what actually is if an efficient policy would have been taken place.

From the above discussion it is clear that the cost of prescription drugs are significantly high is Australia. For example, Anaztrozole is a medicine that is used to cure breast cancer. In US, the market price of 30 tablets of 1mg medicine is $2.45 whereas the same medicine of same quantity in Australia costs $19.20 that is nearly about 10 times more that it cost in US.

There are some reasons behind high cost of drugs in Australia such as:

No Price control- The Australian government has limited or no control over majority drugs that are supplied in the market as a result of which drug makers sets their own price without anyone’s interference.

Competition is Limited – Majority of the drugs in Australia has no real competition to keep the price level at a reasonable rate. Only one or two companies make those drugs as a result of which they charge high price for those medicines.

High cost of Production – Development cost and production cost for few medicines are increasing in Australia. Moreover the cost of conducting research is also becoming quite expensive as a result of which the price of the medicines are also increasing.


The Department of Health, Australian Government, it is found that Atorvastatin is the most commonly prescribed drug in Australia which is used to fight against high blood cholesterol level, curing pneumonia and also to reduce stomach disorders. Perindopril takes the second position in the list used to treat high blood pressure that is the second most frequently used medicine in Australia. At the third place comes Rosuvastatin that is also used to treat heart diseases, high cholesterol level, etc.

The different other types of medicines that are consumed on daily basis in Australia are ESOMEPRAZOLE, PARACETAMOL, PANTOPRAZOLE, PERINDOPRIL, AMOXYCILLIN, CAFALEXIN, AMOXYCILLIN with CLAVULANIC ACID and many more.

The Several issues relating to the Pharmaceutical Benefit Scheme are listed below:

  • Issues regarding confidentiality – Maintaining the confidentiality of Pharmaceutical Benefit Scheme is now a big problem. The government has legally issued clear cut instruction to maintain transparency which include the fact that it is necessary to make the public aware that such system of PBS exist (Daniels et al., 2017 ).
  • Problems of future competitors – The government anticipates that how expansion of the proposed deed is necessary before the enactment of the deed if other medicines are to be used in the same population. Thus, equality among the competing medicines are confirmed by this deed (Faunce, 2015).
  • Problem relating to execution – Execution of the scheme is leading to some issues. The sponsor and the department must negotiate the deed and finalize during PBAC recommendation and PBS listing. Simultaneously with the process of finalizing the prices, they take place. It is also mentioned that both the parties must execute the deed before the cut-off date (Parkinson et al., 2015).
  • Issues regarding timeliness – An essential step towards PBC-subsidizing of a drug is positive recommendation for listing by PBAC. Although before a drug is to be subsidized, there are a certain numbers of steps that are need to be followed and these process entirely consumes a lot of time (Brett et al. 2017). Such steps includes approval from cabinet, pricing, etc

References

Blanch, B., Pearson, S. A., & Haber, P. S. (2014). An overview of the patterns of prescription opioid use, costs and related harms in Australia. British journal of clinical pharmacology, 78(5), 1159-1166.

Brett, J., Karanges, E. A., Daniels, B., Buckley, N. A., Schneider, C., Nassir, A., ... & Pearson, S. A. (2017). Psychotropic medication use in Australia, 2007 to 2015: Changes in annual incidence, prevalence and treatment exposure. Australian & New Zealand Journal of Psychiatry, 0004867417721018.

Currow, D. C., & Sansom, L. N. (2014). Uptake of medicines and prescribing patterns in the palliative care schedule of the Pharmaceutical Benefits Scheme. The Medical journal of Australia, 200(10), 560-561.

Daniels, B., Lord, S. J., Kiely, B. E., Houssami, N., Haywood, P., Lu, C. Y., ... & Pearson, S. A. (2017). Use and outcomes of targeted therapies in early and metastatic HER2-positive breast cancer in Australia: protocol detailing observations in a whole of population cohort. BMJ open, 7(1), e014439.

Faunce, T. (2015). How the Australia-US free trade agreement compromised the pharmaceutical benefits scheme. Australian Journal of International Affairs, 69(5), 473-478.

Mellish, L., Karanges, E. A., Litchfield, M. J., Schaffer, A. L., Blanch, B., Daniels, B. J., ... & Pearson, S. A. (2015). The Australian Pharmaceutical Benefits Scheme data collection: a practical guide for researchers. BMC research notes, 8(1), 634.

Page, E., Kemp-Casey, A., Korda, R., & Banks, E. (2015). Using Australian Pharmaceutical Benefits Scheme data for pharmacoepidemiological research: challenges and approaches. Public Health Res Pract, 25(4), e2541546.

Parkinson, B., Sermet, C., Clement, F., Crausaz, S., Godman, B., Garner, S., ... & Elshaug, A. G. (2015). Disinvestment and value-based purchasing strategies for pharmaceuticals: an international review. Pharmacoeconomics, 33(9), 905-924.

Pearson, S. A., Pesa, N., Langton, J. M., Drew, A., Faedo, M., & Robertson, J. (2015). Studies using Australia's Pharmaceutical Benefits Scheme data for pharmacoepidemiological research: a systematic review of the published literature (1987–2013). Pharmacoepidemiology and drug safety, 24(5), 447-455.

Schaffer, A. L., Buckley, N. A., Cairns, R., & Pearson, S. A. (2016). Interrupted time series analysis of the effect of rescheduling alprazolam in Australia: taking control of prescription drug use. JAMA internal medicine, 176(8), 1223-1225.

Thai, L. P., Moss, J. R., Godman, B., & Vitry, A. I. (2016). Cost driver analysis of statin expenditure on Australia’s Pharmaceutical Benefits Scheme. Expert review of pharmacoeconomics & outcomes research, 16(3), 419-433.

Vitry, A., & Roughead, E. (2014). Managed entry agreements for pharmaceuticals in Australia. Health Policy, 117(3), 345-352.

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