Revised arrangements for the efficient funding of chemotherapy medicines
From 1 December 2011 a new initiative will be introduced with the aim to reduce PBS expenditure on chemotherapy medicines used in the treatment of cancer and administered through intravenous infusion or injection. This will result in changes to the PBS and new remuneration arrangements.
The revised arrangements will result in more cost-efficient prescribing and dispensing practices by:
- requiring prescribers to write dose-specific, infusion and injection-based prescriptions using an appropriate unit of measure without specific reference to forms and strengths, and
- only paying approved suppliers and pharmacies for the most cost-efficient combination of vials that makes up a patient’s dose.
For health professionals who prescribe chemotherapy medicines:
- prescriptions will need to be dose-specific and written in milligrams or other unit of measure as appropriate
- patients will generally pay no more than one co-payment per cycle of treatment (i.e. a co-payment will be paid on each original prescription, but not on each repeat), and
- one prescription is required (either an original or repeat if needed) per infusion or injection.
Note: the number of repeats on the prescription must be clinically appropriate for the treatment protocol that the patient is undergoing and within the parameters set by the Pharmaceutical Benefits Advisory Committee (PBAC). If additional repeats are required an authority will need to be sought.
The revised approach to writing prescriptions will help to reduce waste by limiting the amount of medicine prescribed to the amount required per infusion.
For approved pharmacies that dispense chemotherapy medicines:
- pharmacies will only be paid for the most cost-efficient combination of vials that make up a patient’s dose, and
- the specialist nature of preparing chemotherapy medicines will be acknowledged with a series of new dispensing fees depending on where the medicines are claimed.
These fees include:
- distribution fee
- diluent fee
- preparation fee, and
- dispensing fee.
The revised arrangements will be implemented under a new s100 special arrangement and help the Australian Government support cancer patients by minimising waste and cost of chemotherapy medicines.
All medicine that meets the criteria for inclusion in the measure, including trastuzumab (Herceptin®), will be subject to the new prescribing, dispensing and claiming arrangements.
Note: these arrangements will commence from 1 December 2011 in all sectors, except public hospitals. Public hospitals supplying PBS chemotherapy medicines have a phased implementation from 1 December 2011 until 31 March 2012. In the interim public hospitals can continue to access chemotherapy medicines through the existing Chemotherapy Pharmaceuticals Access Program. For more information on the interim arrangements go to www.pbs.gov.au
PBS general enquiry line 132 290*
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Last updated: 3 April, 2012