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History of the PBS

Discuss about the Scheme Data for Pharmacoepidemiological Research.

The government of Australia uses pharmaceutical Benefits Scheme to subsidize the cost of medicines to all the residents of Australia who are holding a Medicare card. Larger quantities of medicines that are on the PBS are distributed thru community pharmacies. However, some medications are offered in the hospital. The initial attempt to enact a scheme to offer appropriate prescription medicines, for example, antibiotics, without payment to the residents of Australian was established in 1994 by the Curtin Labour Government (Pearson et.al, 2015). However, the court stopped the legislation process. But due to high consumption rates for medicines and the high cost of medicine in the country, a version of PBS started in 1948 with the aim of lowering the cost of medicines by providing medicines free of charge. The Pharmaceutical Benefits Scheme started a comprehensive scheme proposing access to a broader range of medicines in the year 1960. In Australia, PBS is now viewed as the main component of the NMP (National Medicines Policy) which help in improving the outcome of health for the people of Australia (Hajati, Atlantis,  Bell & Girosi, 2018).

Since the introduction of the program, the PBS has developed as the population has aged, the population size has grown, and there is the improvement in medical technology. This factor has increased the cost of the scheme over those periods. It has also increased the cost of medicines which PBS subsidies (Ong, Blanch & Jones, 2018).

The cost of medicine consumption on PBS between 1994 to 1995 and 2004 to 2005 grew by an estimate of 13% each year. Since then the growth rate decreases but the annual rate of growth on the Pharmaceutical Benefits Scheme from 2005- 2006 to 2013-2014 was estimated to be 4.86%. In the recent period, the expenditure has decreased; the PBO (Parliamentary Budget Office) forecasts that in the medium terms the expenditure will level out at 0.3%p.a. The Australia Government expected that the average growth in the longer term would be around 4-5% per annum. There is slowing growth in PBS expenditure because of the various pricing policies put in place in 2005. 

The Government of Australia funds most of the cost that is associated with the scheme. The government spending increases to 0.65% of GDP by 2003-2004. In the recent years, the share of PBS on GDP has been falling.  The patients also contribute to the cost of the scheme, but the government funds large amount to the scheme.

Coverage and Costs of the PBS

The PBS medicines are mainly distributed thru community pharmacies. The medicine offered under PBS have commonly used drugs, for example, drugs use for the treatment of high cholesterol, high blood pressure, infections asthma, diabetes, mental health condition, and depression. Most of the expenditure is provided in the Act (Parkinson et.al, 2015). Some of the most prescribed drugs include: 1) Atorvastatin - it lower the danger of stroke and heart attack, 2) Rosuvastatin- which reduce the risk of heart attack or stroke, 3) Perindopril- it lower blood pressure, 4) Pantoprazole- used for treating heartburn, acid reflux and stomach ulcers. 

There are many issues that affect the PBS, but the most pressing issue is the need to balance the sustainability of finance for the provision of affordable medical prescription. The cost of the scheme is also high with less attention being given to the social, economic, productivity and health benefits. For example, by increasing the spending on the PBS has stimulated savings to different departments of the health system, i.e., hospital costs. There is also the issue of developing a policy that will solve all the problems of the stakeholders in the PBS without affecting the community (Brett et.al, 2017).

There are issues of coverage, pricing, predictability, the efficiency of the process, predictability. There is also the issue of working with the modern technologies, i.e., co-dependent technologies (combination of the medical device). The is also the problem of coming up with the biologic medicines which offer modern treatments in different areas, as well as increasing use of medical instruments which target specific treatments to specific patients (Page, Kemp, Korda & Banks, 2015). Another challenge comes during the listing of the new pharmaceuticals. PBAC determines the cost of new drugs and then recommends whether they should be listed placed on the Pharmaceutical Benefits Scheme. Even though the PBS does not make any budget, any new medicine the Pharmaceutical Benefits Advisory Committee recommends for listing that is above $10 million per annum must be accepted by the Cabinet. Budget pressures are an issue that may prevent the listing process in the PBS. The government should develop price policies that affect pharmacy, manufacturer and the remuneration of the wholesalers. The policies should be changed to ensure that the costs of medicines are being controlled (Schaffer, Buckley, Cairns & Pearson, 2016).

The overuse of medication in Australia was due to intimidation of the prescribers by the individuals who are sick (patients) which lead to inappropriate prescribing. There is the problem of accessing drug treatment problem and pain management. There is also the problem in the planning of hospital discharge process which causes patients to use medications beyond the period stated by the clinical Doctors. The national registration for the health practitioner’s arrangements contributed to overuse of medication in Australia (Harris, Daniels, Ward & Pearson, 2017).

Challenges Facing the PBS

Conclusion

The paper provides an overview of the PBS as used by the Australian government. The scheme helps in the provision of cheap medical services to the Australian residents. It covers the cost of the PBS with the intention of controlling expenditure. The paper also discusses the issues that affect the program (PBS scheme). The policies and reforms that can help improve the use of PBS are also discussed in the paper. The government of Australia should offer subsidies for different medicines being provided under the PBS through LSDP. Today Pharmaceutical Benefits Scheme provides reliable, timely and reasonably price to necessary drugs for the Australians residents. The Austrian government use PBS as a National Medicine Policy. The main aim of the policy is to satisfy the meditational needs of the Australians.

The government should try to find savings for the medicines listed in the existing PBS, through higher patients’ co-payments or price reforms to correct future PBS listing. The government should develop policies that control the operation of the pharmacy (Staatz, Martin, Kong & Hollingworth, 2018). PBS should use cheaper biosimilar medicine to avoid the use of expensive medicines. The government should establish the policy that allows the PBS to provide medicines at the public hospital to outpatients and patients at discharge. The cost of generic medicine should be reduced this will help in solving the issues in the PBS. The government should also seek for saving in the existing PBS listed drugs, by reforming the price to accommodate the drug listing that may take place in the future.

References

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, 51(10), 990-999.

Hajati, F., Atlantis, E., Bell, K. J., & Girosi, F. (2018). Patterns and trends of potentially inappropriate high-density lipoprotein cholesterol testing in Australian adults at high risk of cardiovascular disease from 2008 to 2014: analysis of linked individual patient data from the Australian Medicare Benefits Schedule and Pharmaceutical Benefits Scheme. BMJ open, 8(3), e019041.

Harris, C. A., Daniels, B., Ward, R. L., & Pearson, S. A. (2017). Retrospective comparison of Australia's Pharmaceutical Benefits Scheme claims data with prescription data in HER2-positive early breast cancer patients, 2008-2012. Public Health Research and Practice, 27(5), 1-9.

Karanges, E. A., Blanch, B., Buckley, N. A., & Pearson, S. A. (2016). Twenty?five years of prescription opioid use in Australia: a whole?of?population analysis using pharmaceutical claims. British journal of clinical pharmacology, 82(1), 255-267.

Liu, E., Dyer, S. M., O'Donnell, L. K., Milte, R., Bradley, C., Harrison, S. L., ... & Crotty, M. (2017). Association of cardiovascular system medications with cognitive function and dementia in older adults living in nursing homes in Australia. Journal of geriatric cardiology: JGC, 14(6), 407.

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.

Ong, T. T., Blanch, E. W., & Jones, O. A. (2018). Predicted environmental concentration and fate of the top 10 most dispensed Australian prescription pharmaceuticals. Environmental Science and Pollution Research, 1-11.

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.

Staatz, C. E., Martin, N. S., Kong, D. P., & Hollingworth, S. A. (2018). Patterns in use and costs of subsidising 5-aminosalicyclic acid compounds and biologic agents in the treatment of inflammatory bowel disease in Australia. Digestive and Liver Disease, 50(3), 314-317.

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