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Australian Journal of Pharmacy : April 2005
capital hill capital hill from our Canberra correspondent Floating PBS co-payments— or sinking the PBS? T HE Federal Government has turned its sights on pharmacy as the latest target in a bid to cut rising PBS costs. In typical fashion, the political kite- flying accompanying this initiative wears the familiar weasel word disguises. If you float something, you’re just testing the water. If the something in question has a hole in it, it will sink. Or, if the water’s too deep, you might be in over your head. Worse still, some rotter with an axe to grind might leak. Minister Abbott is becoming proficient in the art of ‘floating’. During the election run up, we had the concept of a 12.5 per cent PBS generic price cut ‘floated’. It’s not clear where Mr Abbott got this from- remember, he’s a self-confessed open mind, and simply wants to explore avenues that are going to deliver improved healthcare. Healthcare, in Mr Abbott’s own words, is an investment, not a cost. However, this whole business of health- care costs is reaching ludicrous extremes. Fact: the Australian population is get- ting older. Fact: the costs associated with maintaining an older population must force healthcare costs upward. Fact: if you as a government want to maintain an age- ing population of people who’ve been dealt iniquitous taxation scales all their working lives, you’d better come up with some long-term viable funding policies that don’t cherrypick by kneejerk reaction and are even-handed in their effects and benefits. Perhaps the floating, more recently, of the idea of floating the patient contribu- tion might be more an indicator of policy on the run than a reflection of a consid- ered, strategic address of a document-now largely and conveniently forgotten— dropped by Peter Costello in the Budget a couple of years ago. It was called the Intergenerational Report and it was suppos- edly a pathway to looking after the baby- booming ‘wanna haves’, ‘must haves’ and ‘wannit anyways’ who have a powerful habit of voting with their hip pockets every three years. Minister Abbott, in floating the floating co-payment concept, appears to be aban- doning bottom-line common sense. In telling an assembly of very keen lis- teners at last month’s APP that he saw no reason why a pharmacist should not be able to charge less than the PBS co-pay- ment, he is ignoring the fundamental cor- nerstone of the Quality Use of Medicines principle. Pharmacy believes that such a move would have exactly the opposite effect to what was sought. The existing Conces- sion/Pensioner prescriptions require an up-front of $4.60—which at present serves as a useful deterrent to prescription drug hoarding. Both the ‘Quality Use of Medicines’ and the National Medicines Policy were designed to prevent this very problem. In submissions to Parliamentary mem- bers on the issue, the Guild under John Bronger is arguing hard that floating the price of patient co-payments will not deliver the PBS savings needed. Without doubt, it will win a few votes among con- cession cardholders and pensioners-but the Guild argues logically that it will sim- ply result in increased hoarding, with a resultant cost blow out to the PBS. In a quiet moment at APP, Mr Bronger and several key members of the fourth Guild-Government negotiating team spent time advising the Minister if phar- macists discount PBS scripts, experience has shown, particularly in the US, that schemes designed to attract patients to pharmacies on price alone result in increased purchases. In a PBS-reimbursed market environment, it will be a disaster. Volume discounts will impact the PBS far 232 ? THE AUSTRALIAN JOURNAL OF PHARMACY VOL.86 APRIL 2005 more than the cost of new high tech pharmaceuticals. You only have to look at the marketing tactics of online pharmacies to see evi- dence of higher than usual drug purchases by inducements to fill all scripts at the same time, paying one delivery fee, or encouragements to buy larger quantities ($10 for 100 tablets $15 for 200 tablets) and so on. Meanwhile, Mr Abbott would do well to regard the mechanism of the Safety Net to see the public mindset in action if he needs any further evidence. The annual bunrush every December among Concession/Safety net cardhold- ers is evidence of stockpiling. The Guild notes a peak in Safety Net squirrelling occurred within just months of the Sena- tor Paterson-inspired Dr James Wright PBS campaign two years ago. The objective of this sought to impress on PBS consumers that they should rush off to a doctor when they caught a cold, but they should not expect a prescription once they there. The results of this $20m worth of taxpayer-funded educational expenditure was to result in a Safety Net blowout of previously unattained propor- tions. Perhaps the advertising campaign served to float no more than a reminder that Safety Net qualifiers needed to line up at the stalls. Mr Abbott needs to ensure that the issues he’s driving in PBS economics make consummate sense. The 12.5 per cent is, in its present form, clumsy and undeliver- able, and the floating of the co-payment might be better forgotten in favour of a more balanced approach to the question of PBS funding overall. ¦ The opinions expressed in this column are not necessarily those of the AJP’s management or staff