Access to high cost drugs in Australia

Risk sharing scheme may set a new paradigm

The Australian pharmaceutical benefits scheme provides universal subsidised access to a wide range of medicines (www.health.gov.au/pbs/). Consumers make a co-payment of $A23.70 (£8.90; €13.50) per prescription ($A3.80 for patients who get concessions) for medicines that cost the government more than this amount (and pay in full for medicines that cost less than $A23.70). Prescription medicines are assessed by the Pharmaceutical Benefits Advisory Committee, which evaluates incremental cost effectiveness (including quality adjusted life years) of the product compared with other treatments that the new treatment could replace.1 Expenditure of the pharmaceutical benefits scheme has been rising at some 10% per year, a rate greater than any other federal health programme, and this situation is considered by many to be economically and politically unsustainable.2^–3 Recent listings of costly medicines used for relatively common conditions, underestimates of prescribing rates for drugs such as celecoxib and omeprazole, and prescribing beyond …