19 August 2021

Many people have asked Painaustralia how they may be able to have a say about pain medications that are under consideration for subsidised listing on the Pharmaceutical Benefits Scheme (PBS). Under the PBS, the Australian government subsidises prescription medicines in order to make them affordable.

The PBS is one of the central components of our health system and ensures that Australian residents are able to access essential prescription medicines without huge cost. This is in sharp contrast to many other countries – most notably the United States – where essential prescription medicines can be very expensive and are effectively out of reach for many.

In Australia, in order to fill a prescription, a consumer will currently only have to make a co-payment of up to $41.30 for most PBS medicines or $6.60 if you have a concession card (pharmacists may also further discount the PBS patient co-payment by up to $1.00). By contrast, in the absence of the PBS subsidy, the actual market cost for that medicine may be several hundreds or even thousands of dollars.

If you have a chronic pain condition, even these subsidised co-payments can soon add up. To address this, there is a safety net which means that once you have paid $1,497.20 or $316.80 (for concession card holders) over the course of a calendar year you don’t need to pay any additional amounts for rest of the year.

The PBS initially came into being in 1948 providing free medicines to pensioners and 139 ‘life saving and disease preventing’ medicines to the general public[1]. Today there are around 8,000 items (which includes different doses and forms of a smaller number of individual medicines) covered by the PBS and costing the Australian government over $43 billion over the next four years ($13.2 billion this year)[2].

While the range of medications covered by the PBS is extensive, the process for getting a medicine listed on the PBS involves a number of hurdles including:

• approval by the Therapeutic Goods Administration (TGA) after considering the safety and efficacy of the product (TGA approval means the product can be legally sold in Australia, but it doesn’t mean that it automatically goes onto the PBS)
• the sponsor needs to apply for listing on the PBS through the Pharmaceutical Benefits Advisory Committee (PBAC) process which assesses clinical effectiveness, safety and cost-effectiveness (‘value for money’) compared with other existing treatments
• If recommended by PBAC, the government will then negotiate with the sponsor on the actual price and conditions of supply. These negotiations can sometimes be complex and protracted - with the government also taking into account the impact of listing on the Budget

It goes without saying that consumers with pain conditions have a very strong interest in the outcomes of PBAC meetings. While governments and health economists focus on potential cost and expenditure, for consumers the impact of being able to access a medicine that can be lifesaving or that can enable huge benefit to quality of life is of critical importance.

In an ideal world, peak bodies would be resourced to provide a more considered and coordinated consumer focused input to the PBAC consideration that is independent (from influence).  Unfortunately, at the moment that is not the case.

It remains important that consumers who have an interest in a new listing do provide their input.

You can provide input on potential listings that will be considered at the next meeting in November where there are several medicines for conditions that are accompanied by pain including spinal muscular atrophy and chronic migraine set down for consideration.  

The agenda for the November meeting can be viewed here:

Pharmaceutical Benefits Scheme (PBS) | PBAC Meeting Agenda

The form for providing comments is linked below.

Department of Health | Online Comments to the Pharmaceutical Benefits Advisory Committee (PBAC)

Comments for the November meeting are due by 5pm on 22 September and will particularly assist the consumer representatives on PBAC to reflect a consumer perspective.

In the absence of appropriate resourcing for peak bodies to provide co-ordinated consumer input, Painaustralia will try to ensure through our social media channels that you are aware of potential new listings relating to pain management and encourage you to make submissions ahead of each PBAC meeting.

Carol Bennett, CEO