The Pharmacy Guild has won the support of an advocacy group after it used its 2021-22 pre-Budget submission to argue for an end to the regulated PBS discrimination against people living with opiate dependence.
The government reimburses treatments for opiate dependence through the PBS but somehow maintains an accompanying regulation that precludes them from PBS funded community pharmacy dispensing arrangements.
The government reimburses the medicine but does not fund the dispensing arrangements.
Under the governing legislation of the PBS (National Health Act 1953), reimbursed treatments for opiate dependence are treated the same as every other medicine - they are required to be dispensed under the identical co-payment and safety-net arrangements.
However, the government gets around this by maintaining a separate and specific regulation excluding them from these arrangements.
The government regulates to discriminate.
It is worth asking how it can regulate in a way that contradicts an act of parliament? How is that lawful, particularly when the impact is to impose a discriminatory outcome on one group of particularly vulnerable people?
It is a remarkable and clearly discriminatory law targeting some of the most vulnerable people in the community who are currently not protected by limits on co-payments for their PBS medicine. What they pay for their treatment does not count towards their safety-net qualification.
It also represents a back-door way for the government to increase patient co-payments and avoid more people qualifying for the safety-net. If they do it for these medicines for opiate dependence, why not smoking cessation or any condition where funding is based on the principle of harm reduction?
The Coalition attempted to increase PBS patient co-payments in the 2014-15 Budget. The enabling legislation did not navigate the parliamentary approval process but, based on their treatment of medicines for opiate dependence, they could have just regulated to remove dispensing fees, co-payment caps and the safety-net qualification.
The implications are significant but it gets even worse.
Under the federal government's Stage Supply arrangements, as a harm reduction measure, it will fund a community pharmacist to dispense a 28-day prescription of opiates to a patient on a daily basis. However, the government does not currently fund the dispensing of a 28-day prescription of treatment for people wanting to cease the use of opiates.
Green Senator Rachel Siewert raised the issue with Department of Health officials at Estimates in October 2020. In response to questions taken on notice, they have not even attempted to defend this regulated discrimination.
"There is no PBS remuneration paid to pharmacy owners for the provision of opiate substitution therapy under the ODTP [Opiate Dependence Treatment Program], and pharmacists may charge patients a private dispensing fee. Some jurisdictions, such as the ACT, subsidise patient fees to pharmacists."
Yes, they actually give this regulated discrimination a name - ODTP. It is Orwellian.
The organisation Harm Reduction Australia (HRA) has consistently argued for change, citing evidence some patients are paying $50 to $200 per month to access PBS-listed treatment for opiate dependence, compared to a concessional co-payment of $6.60 per 28-day prescription for each of the around 1,000 other medicines on the PBS.
In a statement, HRA co-founder Annie Madden AO and president and co-founder Gino Vumbaca said the organisation welcomed the Guild's submission calling for reform of the ODTP and its discrimination against people needing access to the therapies.
"On 1 January 2020 the Health Minister announced the ‘easing of the financial burden’ on patients managing chronic conditions by reducing the concessional PBS safety by 12 scripts from $390.00 to $316.80 and the general PBS safety net from $1550.70 to $1486.80," it said.
"However, the Government eased the burden for every person in Australia except the tens of thousands of people who rely on subsidised access to treatments for opioid dependence.
"The current system precludes access to the PBS safety net for the cost of these medicines and further denies people in need of these treatments the protection afforded to every other PBS consumer by allowing an uncapped dispensing charge which does not count towards their safety net.
"Programs such as the staged supply program to assist with reducing the risk of dependence associated with high-risk medications are also specifically denied to people on the ODT Program."
It said, "This 30-year discrimination against some of the most financially and socially disadvantaged members in our community is simply unjustifiable."
"Accordingly, HRA welcomes the Guild’s Submission supporting our calls for reform as part of the 2020-21 Federal Budget and as part of the current consultation process on the Legislative Instrument that as of 1 February 2021 seeks to enshrine this discrimination once again against people with an opioid dependence."
In its pre-Budget submission, the Pharmacy Guild highlighted the fact there are nearly 150 hospitalisations and 14 emergency department presentations involving opioid harm every day in Australia. It said three people die from drug-induced deaths involving opioid use daily.
"Statistics data shows opioid increased deaths increasing over recent years after significant reductions in the early 2000s," it said.
The Guild said data from the Australian Institute of Health and Welfare shows over 70 per cent of people receive their treatment for opiate dependence via a pharmacy. Yet around 40,000 people are missing out due to a combination of issues to do with affordability or their inability to access state and territory programs.
The Guild has called for action from the federal government that recognises the dispensing of opiate dependence treatment under standard PBS arrangements. That is, it should stop regulating the discriminatory treatment of these patients.
"The Guild recommends the prescribing and dispensing of prescriptions for ODT medicines be aligned with that of other PBS medicines with prescriptions issued by approved prescribers for up to four-weeks’ treatment and five repeats which can be dispensed from the patient’s preferred community pharmacy."
It added, "As with other PBS medicines, the Patient co-payment would also contribute to the PBS Safety Net Record. Such an arrangement would ensure equity of access and limit the patient costs for this essential service to some of the most vulnerable and financially disadvantaged members of our society."
The Guild has also recommended the government introduce a subsidy to pharmacy under which they would receive a fee for dose-management and the provision of takeaway doses for oral ODT medicines. A separate fee would be created to support the in-pharmacy administration of injectable ODT medicines. It estimates the total cost of a program at around $425 million over four years.
