Australia’s ophthalmic sector has welcomed new federal policy allowing 60-day prescribing for stable, ongoing conditions such as severe dry eye and glaucoma, which is expected to improve treatment adherence and save patient costs.
The new measure, announced 26 April, will also mean patients can purchase two months’ worth of medicine for the price of a single prescription. It follows a Pharmaceutical Benefits Advisory Committee (PBAC) recommendation in 2018 that was not implemented by the then-government.
The move affects 320 medicines from 1 September, including more than 80 ocular therapies – most, if not all, are for elevated intraocular pressure and severe dry eye disease.
“The Australian Society of Ophthalmologists (ASO) welcomes any move by government which saves patients money on their prescription medications,” president Dr Peter Sumich said.
“We expect to see improved compliance with glaucoma medication if they have more availability. On many occasions it is the break between scripts where patients fall down on their habit of treatment and compliance is lost.”
Optometry Australia interim CEO Ms Skye Cappuccio said for some optometry patients, the measure is expected to make it easier and more affordable to access medications.
“Many of the details of the approach are not yet clear, and this is something Optometry Australia is monitoring so we can ensure that optometrists are fully updated before the measure comes into effect,” she said.
However, pharmacies are against the move, saying it will lead to the closure of many chemists and reduced opening hours, impacting access to medicines. The Pharmacy Guild of Australia said it may also lead to medicine shortages.
“I don’t want to see a Hunger Games stand-off in any community in Australia where some patients get double the medicine they need, while others get nothing,” the guild’s national president Professor Trent Twomey said.
The government expects general patients to save up to $180 a year if their medicine can be prescribed for 60 days, while concession card holders will save up to $43.80 a year per medicine. At least six million Australians are expected to halve their medicine costs and need fewer visits to the doctors and pharmacist to renew their scripts, saving patients more than $1.6 billion over the next four years, the government said.
The PBAC considered the safety profile of the medicines that it recommended, and it will be up to doctors to make a clinical decision about whether 30-day or 60-day prescribing is appropriate for the individual’s circumstances. In addition to ocular therapies, hundreds of medicines for conditions like heart disease, cholesterol, Crohn disease and hypertension will be cheaper.
Doctors and pharmacists at odds
The change will bring Australia into line with New Zealand, the UK, France and Canada where patients already have access to multiple month medications on a single prescription.
Twomey, from the Pharmacy Guild of Australia, said when a similar policy was introduced in the UK, 1,100 pharmacies shut and when it was introduced in New Zealand more than 70 pharmacies closed.
The government said overall demand for medicines will remain unchanged. It also said the reform will not affect medicine availability nor add to shortages. But Twomey said the health minister refused to guarantee patients would receive the medicine they needed or that pharmacies wouldn’t close.
He quoted data from a World Pharmacy Council economist that said the policy would lead to a $3.5 billion cut in patient care to communities around Australia over the next four years.
“That should worry patients,” he said. “This cut to patient care will mean aged care services are reduced and elderly patients may go without medicine.
“This cut will mean parents wanting access to late night medicines for their kids will miss out because pharmacies will be forced to scale back their opening hours. It will put more pressure on emergency departments because people will need to go somewhere when their pharmacy is closed.”
Twomey said the guild would rather see the PBS co-payment dropped to $19, helping Australians with rising cost of living pressures. But on January 1, for the first time in the 75-year history of the PBS, the co-payment was reduced from $42.50 to $30. In the first three months, 5.1 million prescriptions were cheaper, saving Australians more than $58 million.
Once 60-day prescribing is implemented, the government said every dollar saved by the policy would be reinvested back into community pharmacies “and ensure our trusted pharmacists play an even larger role in the healthcare of Australians”.
Twomey said the guild “would be holding the minister to his word” on this.
The government is also investing $350 million to community pharmacy outreach into aged care facilities to ensure older Australians are managing their medications.
Australian Medical Association (AMA) president Professor Steve Robson said the body had been calling for the change since it was recommended by the PBAC in 2018. The decision will also allow up to 12 months’ supply in total from a single script, also saving patients an extra trip to the doctor.
“This is terrific news for consumers taking these medications, as they will now be able to visit the chemist once every two months instead of every month, but still pay a single co-payment – instead of visiting and paying each and every month,” Robson said.
“We know patients are struggling to afford essential medicines as cost-of-living increases continue to bite the household budget and research tells us some patients are skipping medicines because of this – that just shouldn’t be happening. This effectively halves the costs of these medicines for patients, and means more affordable medicines now are a reality for these patients.”
With regard to medicine shortages, Robson said he didn’t think this would be an issue.
“These are medications that people are taking anyway. All we’re really doing is saying that over the course of a year you need to go to a pharmacy six times to pick up a supply of medication rather than 12 times. It shouldn’t really alter the amount of medication dispensed. In fact, it might make it easier because in any given month, only half as many people will be coming into pharmacies to get their prescriptions,” he said.
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