Readers are invited to write in with their questions about decisions of the Pharmaceutical Benefits Advisory Committee (PBAC). Australian Prescriber publishes selected questions from readers, together with answers from the PBAC. Questions may address issues such as regulatory decisions, pharmaceutical benefits listings and withdrawals.
This exclusive arrangement helps Australian Prescriber readers understand how the contents of the Pharmaceutical Benefits Scheme (PBS, see www.pbs.gov.au) are determined.
Letters and responses are reviewed by the Editorial Executive Committee and may be edited before publication. It may not be possible to reply to all individual questions.
Sir, - I have just had occasion to write a prescription for sertraline for a patient on 150 mg per day.
Costs of pharmaceuticals matter as much for the patient as for the Government. I had originally written out for 28 of the
100 mg tablets plus 28 of the 50 mg tablets, which would have cost $81.01. However, that would have cost the patient two prescription fees per month. By writing the single prescription for 3 of the 50 mg tablets, it will cost the patient only a single prescription fee per month, but in contrast will cost the Government $109.50.
It would be cheaper than the present arrangement for both patient and Government if it were possible to write two strengths of the one medicine on a single prescription form to have prescribed as a single prescription. No doubt, the present arrangement suits the company better, but seems of little merit to either patient or Government.
I do not know if this is an isolated instance, or something which is a more general issue that may be useful for the PBAC's attention.
I hope you do not mind my bringing this to your attention, but the issue of cost awareness has been brought home to medical practitioners and for this reason I have written.
This letter was referred by the PBAC secretariat to the Director, Pharmacy Restructuring and Legislation Section, Pharmaceutical Benefits Branch of the Department of Health and Family Services for reply:
Under the National Health Act 1953, a patient co-payment is payable for each supply of each pharmaceutical benefit. Where there are several forms or strengths of a drug listed as pharmaceutical benefits, these are regarded as being different pharmaceutical benefits and so each attracts a patient co-payment, whether or not it is prescribed in conjunction with another form or strength of that drug.
I presume you mean that you obtained an authority approval for an increased quantity of the 50 mg tablets, as it is illegal to write more than one prescription for a patient for a particular pharmaceutical benefit on the same day. With authorities for increased quantities, only one dispensing fee applies, as well as one patient co-payment. This reduces the cost difference to some extent.
I acknowledge your point about the extra cost; however, the doses you refer to are quite high, and since the Pharmaceutical Benefits Scheme operates for the whole community, it is sometimes difficult to adjust the Scheme for events which could lead to blow-outs elsewhere.
In some situations such as this, the patient can break a tablet to achieve a smaller dose.