Unravelling Australia’s Pharmaceutical Benefits Scheme

Today’s post comes to us from Mark Henderson of GLOBALHealthPR Australia Partner, VIVA! Communications.

The Pharmaceutical Benefits Scheme, or PBS, is a programme administered by the Australian Government to provide patients with heavily subsidised access to a broad range of prescription medicines. Despite its expansion over the years, access to treatments for some rare disorders under the PBS remains elusive today.

Earlier this month, the Medical Journal of Australia (MJA) published an article on the history of the PBS, entitled ‘How the Pharmaceutical Benefits Scheme began.’

This government scheme, with which all Australians are familiar and use, took years from inception to operation.

In 1944, under the leadership of the then Prime Minister, John Curtin, the wartime government introduced legislation for the Pharmaceutical Benefits Scheme. This legislation came in response to a national need for medicines including sulphonamides, streptomycin, and penicillin to be made available to all Australians, not only the wealthy.

Under this bill, any Australian resident could access medicine at no charge after presenting a doctor’s prescription to their Pharmacist. The government would then subsidise the costs.

The bill was opposed by 98 per cent of doctors in Australia, with the British Medical Association (BMA) fighting to ensure it was not passed, even taking the matter to the High Court in 1945 where it was defeated.

In 1947, after narrowly avoiding being outlawed as part of the Constitution, The Pharmaceutical Benefits Act 1947 was tabled. The Act was challenged again by the BMA, but this time for being too narrow as opposed to broad scale.

The BMA made an offer to the government for a limited range of medicines including penicillin, sulfa treatments, vaccines, serums, diphtheria toxin and insulin to be made available on the PBS. This offer was rejected and arguments continued. Meanwhile Australians were still unable to access free or (in many cases) affordable medicines.

In the 1950s, there were ongoing arguments regarding the implementation of a PBS, which saw a ‘safety-net’ scheme put in place for a few years, from 1950-1953, when the government passed its own National Health Act, which took over the ‘safety-net’ scheme. A Pharmaceutical Benefits Advisory Committee (PBAC), nominated by the BMA, was established to advise which therapies could be included under this programme, limited to a very small number of “life-saving and expensive therapies”.

Over time, the race for medicines continued, with new and improved products entering the market.

In 1960, 16 years after its initial introduction by Prime Minister Curtin, the PBS was finally extended to include a more comprehensive list of medications, marking the beginnings of the scheme as we know it today.

Today the PBS forms part of the Australian Government’s broader National Medicines Policy, under which the government subsidises the cost of medicines for most medical conditions, utilising a co-payment model. In January, 2014, the co-payment for an average Australian resident was $36.90, while Australians with a concession card paid only $6.00. The Australian government foots the remainder of the bill.

The list of therapies listed under the PBS, which is available to all Australian residents who hold a current Medicare card, is extensive..

Visitors from countries with which Australia has a Reciprocal Health Care Agreement  (RHCA) are also eligible to access the Scheme, including the United Kingdom, Ireland, New Zealand, Malta, Italy, Sweden, the Netherlands, Finland, Norway, Belgium and Slovenia.

Many battles continued to be waged by pharmaceutical companies and patients to list treatments on the PBS.

Of note is the case of Soliris (eculizumab) – the only treatment available and clinically proven to prevent premature death and vital organ damage in those living with atypical hemolytic-uremic syndrome, or aHUS.

Soliris was approved for use by the Therapeutic Goods Administration (TGA) in October, 2012. However, unlike 30 other countries, including the USA, UK, Canada, Germany and France that are providing their aHUS patients with access to the cost-prohibitive treatment through government-funded programs or private health insurance initiatives, Australia is lagging behind.

At a current, unsubsidised cost of more than $500,000 per adult per year, this treatment is completely out of reach of every Australian living with, or caring for someone with aHUS. Yet it represents their only hope for life.

As the government and manufacturer continue their negotiations to fund this life-saving treatment through the proposed PBS: Section 100: Highly Specialised Drugs Programme, aHUS lives hang dangerously in the balance. Learn more here.