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Health System Sustainability: The Pharmaceutical Benefits Scheme in Australia

  • Joanne EppEmail author
  • Bonny Parkinson
  • Sally Hawse
Chapter

Abstract

The Australian Federal Government’s National Medicines Policy aims to create positive health outcomes for all Australians by providing appropriate access to medicines. Underpinning the policy is the Pharmaceutical Benefits Scheme (PBS), which subsidises the cost of medicines. However, like many healthcare systems around the world, governments are struggling with the challenge of how to manage escalating healthcare expenditure. The landscape is dotted with competing agendas: increased demand for healthcare due to population growth and ageing; patient preferences over treatment options; improved technologies and medicines; the need for pharmaceutical companies to recoup research and manufacturing costs—all have been seen as culprits behind a rising national healthcare bill. Further, spending a dollar on one form of healthcare means not spending a dollar on another. In other words, providing healthcare has an opportunity cost. Increasingly, decision-makers are using economic evaluations as a tool to balance these agenda trade-offs. Only through balance can we ensure that healthcare continues to provide value for money and the system remains sustainable. This chapter explains how the PBS works—its decision-making bodies and processes, how economic evaluation is key to recommending which new medicines are listed on the PBS, and the industry’s perspective on the PBS. The case study focuses on the human papillomavirus (HPV) vaccine to highlight the competing resource demands, business interests, and societal needs that influenced its listing on the PBS. The case study also considers how making the vaccine available through the National Immunisation Programme has contributed to making Australia’s healthcare system more sustainable.

Keywords

Vaccine Human papillomavirus (HPV) Pharmaceutical Benefits Scheme (PBS) Health technology assessment (HTA) Economic evaluation Health system sustainability 

References

  1. Amendment to the National Health Act 1953 Subsection 3(a). Commonwealth Government of AustraliaGoogle Scholar
  2. Australian Institute of Health and Welfare (2018) Australia’s health 2018. Australian Institute of Health and Welfare, Canberra, ACTGoogle Scholar
  3. Bulfone L (2009) High prices for generics in Australia—more competition might help. Austr Health Rev 33:200–214CrossRefGoogle Scholar
  4. Cancer Council Australia (2017) HPV vaccine. Cancer Council Australia, Victoria, Australia. Retrieved from http://www.hpvvaccine.org.au/parents/parents-what-is-hpv.aspx
  5. Clarke PM, Fitzgerald EM (2010) Expiry of patent protection on statins: effects on pharmaceutical expenditure in Australia. Med J Aust 192:633–636CrossRefGoogle Scholar
  6. Crisp N (2017) What would a sustainable health and care system look like? BMJ 358:1–3Google Scholar
  7. Department of Health (2015) Annual Report 2014–2015. Commonwealth of Australia, Canberra, ACTGoogle Scholar
  8. Department of Health (2017) The Australian immunisation handbook, 10th edn. Commonwealth of Australia, Canberra, ACTGoogle Scholar
  9. Department of Health (2018a) National cervical screening program. Department of Health, Canberra, ACT. Retrieved from http://www.cancerscreening.gov.au/internet/screening/publishing.nsf/Content/about-the-new-test
  10. Department of Health (2018b) Price disclosure. Retrieved from http://www.pbs.gov.au/info/industry/pricing/price-disclosure-spd
  11. Department of Health (2018c) Fees, patient contributions and safety net thresholds. Retrieved from http://www.pbs.gov.au/info/healthpro/explanatory-notes/front/fee
  12. Department of Health (2019) Historical pharmaceutical benefits scheme expenditure (1948–49 to 2017–18). Retrieved from http://www.pbs.gov.au/info/statistics/expenditure-prescriptions/expenditure-prescriptions-twelve-months-to-30-june-2018
  13. Department of Health and Ageing (2000) National medicines policy. Department of Health and Ageing, CanberraGoogle Scholar
  14. Dimmock NJ, Easton AJ, Leppard KN (2007) Introduction to modern virology. UK, Blackwell Publishing, OxfordGoogle Scholar
  15. Drummond MF, Sculpher MJ, Claxton K, Stoddart GL, Torrance GW (2015) Methods for the economic evaluation of health care programmes. Oxford University Press, OxfordGoogle Scholar
  16. Frazer I (2016) 2016: 10th anniversary of world’s first HPV vaccine. Australian Cancer Research Foundation (ACRF). Retrieved from https://home.cancerresearch/10th-anniversary-of-worlds-first-hpv-vaccine/
  17. GSK Australia and ViiV Healthcare (2018) The pharmaceutical benefits scheme in Australia: an explainer on system components. GSK AustraliaGoogle Scholar
  18. Haas M, Ashton T, Kerstin B, Christiansen T, Conis E, Crivelli L, Kin LM, Lisac M, Macadam M, Schlette S (2009) Drugs, sex, money and power: an HPV vaccine case study. Health Policy 92:288–295CrossRefGoogle Scholar
  19. Harris AH, Hill SR, Chin G, Li JJ, Walkom E (2008) The role of value for money in public insurance coverage decisions for drugs in Australia: a retrospective analysis 1994–2004. Med Decis Making 28:713–722CrossRefGoogle Scholar
  20. Hynd A, Roughead E, Preen D, Glover J, Bulsara M, Semmens J (2008) The impact of co-payment increases on dispensings of government-subsidised medicines in Australia. Pharmacoepidemiol Drug Saf 17:1091–1099CrossRefGoogle Scholar
  21. International Society for Pharmacoeconomics and Outcomes Research (2018) Pharmacoeconomic guidelines around the world. Retrieved from https://www.ispor.org/PEguidelines/
  22. Jonsson E, Banta D (1999) Management of health technologies: an international view. BMJ British Med J 319:1293CrossRefGoogle Scholar
  23. Krelle R (2005) CSL, Merck strengthen bid to be first to market with HPV vaccine. Retrieved from https://www.labonline.com.au/content/life-scientist/news/csl-merck-strengthen-bid-to-be-first-to-market-with-hpv-vaccine-1142801499
  24. Lavelle P (2006) Saving money on medicines. ABC. Retrieved from http://www.abc.net.au/health/consumerguides/stories/2006/04/17/1837734.htm
  25. Lofgren H (2007) Reshaping Australian drug policy: the dilemmas of generic medicines policy. Australian and New Zealand Health Policy 4:11CrossRefGoogle Scholar
  26. McNeil C (2006) Who invented the VLP cervical cancer vaccines? J Natl Cancer Inst 98:433CrossRefGoogle Scholar
  27. Medicines Australia (2017) Strengthening the PBS: agreement with medicines Australia on behalf of the innovative medicines sector. Canberra, MA. Retrieved from https://medicinesaustralia.com.au/wp-content/uploads/sites/52/2017/05/09-May-2017-Summary-Document-Strenghtening-the-PBS.pdf
  28. Moss E (2017) Ten years on, Professor Ian Frazer recalls ‘lucky’ discovery of cervical cancer vaccine. ABC. Retrieved from http://www.abc.net.au/news/2017-03-25/ian-frazer-recalls-lucky-discovery-of-cervical-cancer-vaccine/8385872
  29. National Health Act (1953) Commonwealth Government of Australia. Retrieved from https://www.legislation.gov.au/Details/C2018C00308
  30. National Cancer Institute (2018) Human papillomavirus vaccines (HPV). NCI. Retrieved from https://www.cancer.gov/about-cancer/causes-prevention/risk/infectious-agents/hpv-vaccine-fact-sheet
  31. Parkinson B (2013) Pharmaceutical policy in Australia. CHERE Working Paper 2013/01. UTS, Sydney, Australia, CHERE, University of Technology, SydneyGoogle Scholar
  32. Parliament of Australia (2016) The pharmaceutical benefits scheme: a quick guide. Commonwealth of Australia, Canberra, ACT, 7 Apr 2016Google Scholar
  33. Pharmaceutical Benefits Advisory Committee (2007) Public summary document for quadrivalent human papillomavirus (Types 6, 11, 16, 18) recombinant vaccine, injection, 0.5 mL, Gardasil. Commonwealth of Australia, Canberra, ACTGoogle Scholar
  34. Pharmaceutical Benefits Advisory Committee (2011) Public summary document for quadrivalent human papillomavirus (Types 6, 11, 16, 18) recombinant vaccine, injection, 0.5 mL, Gardasil. Commonwealth of Australia, Canberra, ACTGoogle Scholar
  35. Pharmaceutical Benefits Advisory Committee (2016) Guidelines for preparing submissions to the Pharmaceutical Benefits Advisory Committee (PBAC). Retrieved from https://pbac.pbs.gov.au/
  36. Pharmaceutical Benefits Advisory Committee (2017) Public summary document: Human papillomavirus 9-valent vaccine: injection 0.5 mL, pre-filled Syringe Gardasil® 9. Commonwealth of Australia, Canberra, ACTGoogle Scholar
  37. Pharmaceutical Benefits Advisory Committee December (2008) Guidelines for preparing submissions to the Pharmaceutical Benefits Advisory Committee (Version 4.3). Department of Health and Ageing, Canberra, ACTGoogle Scholar
  38. PWC (2015) Challenges and change: a report on the Australian pharmaceutical industry. PWC, SydneyGoogle Scholar
  39. Productivity Commission (2005) Impacts of advances in medical technology in Australia, research report. Melbourne, PCGoogle Scholar
  40. Raftery JP (2008) Paying for costly pharmaceuticals: regulation of new drugs in Australia, England and New Zealand. Med J Aust 188:26CrossRefGoogle Scholar
  41. Sloan C (1995) A history of the Pharmaceutical Benefits Scheme 1947–1992. Commonwealth Department of Human Services and Health, CanberraGoogle Scholar
  42. Sweeny K (2013) The impact of further PBS reforms: report to medicines Australia. Victoria UniversityGoogle Scholar
  43. Tabrizi SN, Brotherton JM, Kaldor JM, Skinner SR, Cummins E, Liu B, Bateson D, Mcnamee K, Garefalakis M, Garland SM (2012) Fall in human papillomavirus prevalence following a national vaccination program. J Infect Dis 206:1645–1651CrossRefGoogle Scholar
  44. Viney R, Haywood P, De Abreu Lourenco R (2017) Explainer: how is the price of medicine decided in Australia? The conversation. Retrieved from https://theconversation.com/explainer-how-is-the-price-of-medicine-decided-in-australia-83633
  45. WHO (2011) Health technology assessment of medical devices. World Health Organisation. Retrieved from http://apps.who.int/medicinedocs/en/d/Js21560en/
  46. WHO (2018) WHO essential medicines list (EML). World Health Organisation. Retrieved from http://www.who.int/medicines/publications/essentialmedicines/en/
  47. Zhou J, Sun XY, Stenzel DJ, Frazer IH (1991) Expression of vaccinia recombinant HPV 16 L1 and L2 ORF proteins in epithelial cells is sufficient for assembly of HPV virion-like particles. Virology 185:251–257CrossRefGoogle Scholar
  48. Zur Hausen H (1976) Condylomata acuminata and human genital cancer. Can Res 36:794Google Scholar

Copyright information

© Springer Nature Singapore Pte Ltd. 2020

Authors and Affiliations

  1. 1.Macquarie University Centre for the Health EconomySydneyAustralia

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