The Australian national publicly subsidized: LISTING OF DRUGS FOR PAYMENT BY THE NATIONAL PBS(2)
The major aim of the restriction system is to try to direct use of a drug to the population in which it is most likely to be cost effective. An ‘authority listing’ means that approval must be sought from the Department of Health and Family Services before a physician can prescribe the drug. The authority may be contingent on the indication or the duration of use, and although there is a 24 h/day telephone approval system, the authority requirement can be a significant barrier to the use of a drug. An example of a drug requiring authority prescription is famciclovir, which is approved for the treatment of patients with herpes zoster in whom the duration of the rash is less than 72 h. A ‘restricted’ listing is less restrictive than an ‘authority’ listing but still imposes conditions upon the use of a drug . Restrictions may vary with different dosage forms or strengths. An example is fusidic acid, which is restricted for use in combination with another antibiotic — buy antibiotics online, in the treatment of proven serious staphylococcal infections.
While some audits of outlying prescribers occur, mechanisms to determine whether restricted benefit drugs are prescribed according to the guidelines given are few. In 1995,14% of drugs on the PBS were subjected to cost effectiveness requirements . In general, the PBS does not list drugs for indications that are not approved by the TGA in Australia, although there is no good mechanism to restrict use of a drug to the listed indication except for authority listing . The scheme has levels of copayment and deductibles based on a patient’s age and income. For patients eligible for concessional benefits (those on a low income or in receipt of social security payments) there is a $3.20 copayment per prescription (as of January 1997), which is removed once the patient reaches a deductible of $140.40 (after this amount all remaining prescriptions in a calendar year are free of charge). Pensioners are compensated in their pension for the annual maximum cost of copayments. For general patients, there is a copayment of $20.00/prescription up to a $600 deductible per year (ie, once patients and their immediate family have reached this amount in one calendar year, prescriptions for the remainder of the year cost $3.20 each) . PBS copayments cannot be refunded from private health insurance and are not discountable by pharmacists .
Tags: Australian Pharmaceutical Benefits Scheme, Canadian health care, Pharmaceutical policy, Pharmacoeconomics