A move is underway to use Senate consideration of the general co-payment reduction to secure ministerial action on another PBS issue that currently impacts over 50,000 Australian patients.
The Senate is due to consider the National Health Amendment (General Co-payment) Bill 2022 on Wednesday. The Bill will reduce the general PBS co-payment from $42.50 to $30 on 1 January 2023.
The Bill is considered a crucial component of the Albanese government's first Budget and its political response to the rising cost of living.
Health minister Mark Butler recently confirmed that the Budget will include the almost $800 million cost of the reduction.
The Bill has previously been considered likely to quickly navigate the Senate process with no debate as 'non-controversial', partly because the Coalition made its own pre-election commitment to reduce the out-of-pocket cost of prescription medicines.
However, independent Senator David Pocock has confirmed to BioPharmaDispatch that he has raised concerns with Minister Butler and might seek support for an amendment that would compel the government to provide certain commitments in relation to the Opiate Dependence Treatment Program (ODTP).
The move is unlikely to threaten passage of the Bill but it could delay endorsement by the Senate that was expected this week. It could also provide hope for the resolution of a major affordability issue that a recent coronial inquest identified as contributing to three deaths every day.
The ODTP is how the government reimburses medicines for the treatment of opiate dependence. However, the 'special arrangement' under which it operates removes basic PBS protections for patients who are considered to be living with a disability. The issue is further compounded by the fact the arrangement is not enforced through a legislative instrument, which makes it potentially unlawful.
"The research is pretty clear that people are struggling to afford treatments for opioid dependence under current arrangements, with some people having to make impossible decisions about whether to eat or stay on treatment," said Senator Pocock.
"Multiple coronial inquests have found that many opioid-related deaths could be completely prevented, if these treatments were more available and more affordable.
"Our Pharmaceutical Benefits Scheme is supposed to provide universal, affordable access to PBS medicines. Yet, we have a situation where an instrument has been, potentially unlawfully, enacted to remove the protections of the PBS from people trying to access these treatments.
"Community pharmacy are also paying the price for this, as pharmacists are forced to make compassionate decisions to forego their dispensing fees to help their patients stay on their treatments. I really applaud community pharmacy for this, but it's not something we should be making them do in the first place.
"The Parliament has never been given an opportunity to look at this program, because it has been enacted as an instrument rather than a legislative instrument, and I don't think that's appropriate.
"I've put my thoughts forward to the Government last week and am considering an amendment to the National Health Amendment (General Co-payment) Bill 2022 that would give Parliament greater oversight of this arrangement," added Senator Pocock.
Better Access Australia has been publicly advocating for reform of the ODTP since 2019, including through regular engagement with Senators and committees.
“Better Access Australia is incredibly grateful for Senator Pocock’s interest in stopping the perpetuation of the financial discrimination against patients who access opiate dependence treatment medicines on the PBS," said chair Felicity McNeill PSM.
"It’s discriminatory for all patients seeking treatment and unfair to pharmacy who are caught in the middle.
“The current general co-pay legislation before the Parliament is a long overdue reform, but will ironically exacerbate the discrimination against these patients who are paying over $200 a month to access PBS medicines. One in ten patients accessing this program identifies as an Aboriginal or Torres Strait Islander. When our Parliament is seeking to address the horrendous health outcomes for First Nations People through the Closing the Gap program, the Government’s administration of the ODT Program dismisses that commitment out of hand.
“It’s just wrong.
“Senator Pocock’s commitment to raising this issue as part of the PBS Co-Payment legislation is yet another step from the Parliament trying to protect patients and their families.
"We thank Senator Pocock and his office for their work on this issue, and also thank the Senate Delegated Legislation Committee and Joint Committee Human Rights for their commitment to investigate this Program.
"We acknowledge the foundation work of former Senator Siewert and Senator Steele-John on this issue over the past two years and look forward to working with the Senate to fix this once and for all.
“Because with three people dying every day – #enoughisenough," added Ms McNeill.
Minister Butler's office was approached for comment but had not responded at the time of publication.
