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The Cost of the PBS is in the news again with the Government attempting to increase the patient co-payment as a means of maintaining the viability of the scheme. This article looks at alternatives and will be followed by an analysis of the interest groups that contribute to the increasing costs of the PBS

The decision by the Government to increase the patient contribution to rein in the increasing the cost of the Pharmaceutical Benefits Scheme (PBS) reeks of the "easy way out."
It (the Government) should make sure what it is spending now on behalf of taxpayers is being spent in the most cost efficient manner. To place an increased burden on taxpayers already being hit hard hit is to hit the persons (consumers) least likely to be organised in a manner to cause trouble.
The funds have been stripped from their representative organisations to make sure they cannot afford to make a noise.
The next election is too far off to create a problem and by the time it is held the new charges will be well and truly in place.
The other groups that could have been subject to change are organised in a manner that will embarrass the Government at any time.

Reference here is to the other key stakeholders in the PBS, namely

· Doctors
· Pharmacists
· Manufacturers/ Advertising Agents

Any of these "pressure or lobby groups" are capable of quick response when it is suggested they may be costing taxpayers too much.
But before this there is the need for a thorough cost benefit analysis on the PBS before there is any more "tinkering at the edges".
The facts following this will lead to recommendations on the best options for change to curb increasing expenditure (on the PBS by Government).
In other words give us the facts, not the rhetoric.
With the proposed increase in patient co payment consumers were lead to believe the cost of ALL prescriptions was "going up".
This is nonsense and pharmacists know it.
But how many refuted the assertion?
They did not because they did not want the attention drawn to themselves.
The same goes for the doctors' who order the supply and are most vulnerable for criticism.
Only the manufacturers caused a comment in an attempt to stay onside with consumers in a strategic manner.
There was not even the usual "it is not going into our pockets" plea from retail pharmacists.
The following questions need an answer:

1. Is the PBS meeting its objectives of improving the health of ALL Australians?
2. Could the current spend of over $4 billion be curbed by reducing waste?
3. Are there sufficient checks in place to ensure the current spend is being utilised in the best possible manner?
4. Are there any more cost efficient ways of supplying PBS to the total population?

Now look at these issues one at a time.

1. Is the PBS meeting its objectives of improving the health of ALL Australians?

A considerable amount of money is available for pharmacy practice research and it is hoped that some of this is going towards evaluating current practice models.
The PBS brings in over 60% of revenue to the "average" pharmacy and therefore must be considered a target for detailed study.
Maybe the pharmacy schools at universities around Australia could address this if not already doing so. The research section for the Third Pharmacy Agreement at Guild headquarters in Canberra should be able to answer this question.

2. Could the current spend of over $4 billion be curbed by reducing waste?

Every time there is a "medidump" or similar collection of unwanted medicines campaign there is an immediate pile of waste and full yellow bins and bags right across the country.
The OPAL-RUM (Return of Unwanted Medicines) organisation should be able to give a figure on this.
The fact it receives generous funding from the Government to collect the waste should not deter it from giving the facts.
All pharmacists know too of the waste from people not taking their medicines.
Maybe they do not want to rock the boat in case the unit sale decreases!

3. Are there sufficient checks in place to ensure the current spend is being utilised in the best possible manner?

The simple answer is no.
There are no incentives in the system to ensure patient compliance; supply as needed by pharmacist; or prescribe only when necessary by doctors.
There is no attempt to pay for the cost of dose administration aids (Websterpaks and the like) as part of a dispensing fee.
In fact the desire of pharmacists to "dispense" means this useful aid to compliance is given no value by some pharmacies so anxious for PBS "business" they give them away for no charge.

4. Are there any more cost efficient ways of supplying PBS to the total Population?

The Pharmacy Guild for 40 years has enabled the dispensing fee for PBS to be based on the average cost of dispensing.
This means the pharmacy in Gove or Cooktown gets paid the same as the pharmacy in Pitt Street or Woden to dispense a PBS prescription (1).
The motivation for this is the Guild charter to assist all pharmacy owners.
It cannot discriminate by distance, location or efficiency.
The cost to consumer comes last in this calculation as the Guild is intent on improving the profitability of its members, and rightly so as that is what they (the members) pay for the Guild to do.

A further article in the next edition of I2P will look at the merits of the three lobby groups- the AMA, Guild and Medicines Australia - at assisting Government to equitably provide PBS to the Australian population in a manner that is not influenced by sectional interests.

(1)The rural practice allowance has done something to offset this in recent years but this is based on volume, not efficiency.