PBS medicines in hospitals — Australia's quiet success story

By Kristin Michaels*
Tuesday, 10 October, 2017

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Since 2002, most Australian states and territories have signed up to the Public Hospitals Pharmaceutical Reform Agreement to enable hospital access to PBS funding in some capacity, playing an important role in supporting equitable medicine access. Adoption by NSW and the ACT would cement this landmark program for future generations.

Australian public health policy has led to standout achievements in recent years — increasing vaccination rates, preventing the transmission and spread of HIV, reducing the occurrence of SIDS, and introducing curative medicines for Hepatitis C all come to mind. However, another major initiative has had a strong and growing impact on public health, away from the headlines.

Over the last 15 years, the Pharmaceutical Benefit Scheme (PBS) medicines in hospitals program has supported the supply of medicines for people being discharged from hospital, accessing chemotherapy or attending outpatient clinics.

Previously, supply of medicines in public hospital settings was determined by hospital budgets and managed at a pharmacy-by-pharmacy level. These operational and financial pressures meant that access was sometimes capped, and patients received less than a week’s worth of medicines on discharge; increasing demand for general practitioner appointments and contributing to reduced medicine adherence — the most common reason for rehospitalisation, especially for older people.

Today, comprising more than 20% of PBS expenditure, the PBS medicines in hospitals program plays an important role in supporting equitable medicine access (and high-quality clinical pharmacy care) for all Australians in line with the National Medicines Policy. Every year hospital pharmacists dispense, counsel and provide clinical review for Australians across 10.3 million hospital care episodes as they transition back to community care. In addition, the provision of equitable funding for chemotherapy services through the PBS has enabled the increased delivery of chemotherapy in regional and rural hospitals and clinics.

Since its introduction in 2002, most Australian states and territories have signed up to the Public Hospitals Pharmaceutical Reform Agreement to enable hospital access to PBS funding in some capacity. In Victoria, South Australia, Western Australia, Tasmania and Queensland the PBS medicines in hospitals program has been fully embedded into hospital pharmacy service provision. In the Northern Territory, it has been partially adopted to support chemotherapy access.

Patients in non-signatory New South Wales and the Australian Capital Territory are not able to access PBS-supported medicines in public hospitals for a range of serious conditions or medicines on discharge, typically receiving medicine supply for 2–3 days rather than 30. Although the NSW government has exempted patients from consumer charges for chemotherapy for 2016–2017, pharmacists from SHPA’s NSW Branch continue to advocate for PBS adoption, which they believe will address the recommendations of the 2009 Commission into Public Hospital Services (Garling Report) that specifically flagged underuse of clinical pharmacy services as detrimental to patient care.

Evidence tells us that increased provision of clinical pharmacy services in hospitals improves patient outcomes, reduces rates of rehospitalisation, improves prescriber efficacy and saves money. In fact, previous economic analysis has indicated expenditure on medicine decreases in excess of five-fold for every dollar of pharmacy salary spent per bed day. While public hospital reimbursement is lower than remuneration for dispensing by community pharmacies, the confidence of consistent remuneration for medicine management which meets the quality guidelines mandated by the Australian Pharmacy Advisory Council has enhanced the model of care provided by pharmacists in hospital settings.

The PBS medicines in hospitals program is a quiet and ongoing success story of Australian health policy, and a credit to the Australian government. It represents the best effort in Australia so far to address the challenges of transitional care, and reduce the risk of rehospitalisation for Australians with chronic conditions and complex multi-morbidities — a growing concern as the casemix of public hospital care shifts to respond to our ageing population.

In response to a recent review of the PBS medicines in hospitals program, SHPA identified a range of opportunities to further enhance medicine access, and create even greater value for the Australian public. One example, allowing hospital doctors, as well as general practitioners, to provide Closing The Gap prescriptions, would make medicines more accessible for Indigenous patients, as this exclusion currently inhibits access in the PBS environment.

Responding to the interdependence of medicines, pharmacy services and hospital care, the PBS medicines in hospitals program represents a successful collaboration between federal and state governments and continues to deliver widespread value for Australians. Adoption by Australia’s most populous state and territory would cement this landmark reform for the benefit of future generations.

*Kristin Michaels is the Chief Executive Officer of The Society of Hospital Pharmacists of Australia, with a keen interest and experience in health system design. She is a seasoned board director in primary, acute and aged care sectors. Kristin holds qualifications in arts, organisational leadership, governance and health service management. She is a Fellow of the Australian Institute of Company Directors and is accredited as an International Partnership Broker. SHPA sits within the Australian Digital Health Agency’s (ADHA) Medication Safety Program Steering Group.

Image credit: ©stock.adobe.com/au/Monkey Business

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