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Thursday, 8 February 2007
Page: 8

Mr Murphy asked the Minister for Health and Ageing, in writing, on 14 September 2006:

(1)   Further to his reply to Part (2) of question No. 1647 (Hansard, 11 August 2005, page 211,) on what date did he first receive advice from the Pharmaceutical Benefits Advisory Committee regarding the delisting of calcium tablets from the Pharmaceutical Benefits Scheme and what were the details of that advice.

(2)   Has he read the article titled ‘Abbott urged to keep calcium cheap’ published in the Sydney Morning Herald on 9 August 2005.

(3)   Further to his reply to Part (5) of question No. 1647 that subsidies for calcium tablets make only a small difference in affordability for individuals, what is his reply to that part of the article which states that “the patients most likely to need calcium tended to be on aged-pension cards and often already had to take a variety of other medicines”.

(4)   What is his response to comments by Professor Lyn March of the Australian Rheumatology Association that “Mr Abbott’s comment that paying full price for calcium supplements is relatively inexpensive is just nonsense to these people”.

(5)   Can he be certain that older Australians on low incomes who require multiple medications are not being disadvantaged by having to pay full price for calcium supplements; if not, why not.

(6)   Can he advise whether medications have been subsidised by the government in the past without the recommendation of the Pharmaceutical Benefits Advisory Committee, and if so, what drugs.

(7)   Will he now act to prevent the additional cost of calcium tablets being imposed on older Australians, including those suffering from, or at severe risk of, osteoporosis; if not, why not; if so, when.

Mr Abbott (Minister for Health and Ageing) —The answer to the honourable member’s question is as follows:

(1)   With regards to the delisting of calcium tablets from the Pharmaceutical Benefits Scheme (PBS), the Pharmaceutical Benefits Advisory Committee (PBAC) provided advice between 6-8 July 2005. The advice was tabled in Parliament on 31 October 2005, and is attached.

(2)   Yes.

(3)   For patients with chronic renal failure calcium tablets remain subsidised. For patients other than those with chronic renal failure, calcium supplements remain relatively inexpensive at doses used to treat osteoporosis and other conditions. They are widely available as over-the-counter products. Calcium tablets, such as Caltrate and Citracal, are available for around $13 to $15 for two months’ supply of 120 tablets or $7 per month.

(4)   Professor March’s comments were noted.

(5)   The Commonwealth Government takes great care with its decisions on drug listing and pricing and aims to keep medicines affordable for all Australians. It must also keep the PBS affordable into the future.

(6)   Some medications rejected by the Pharmaceutical Benefits Advisory Committee (PBAC) have been referred to other programs, such as the Lifesaving Drugs Program and the Herceptin Program.

(7)   As a result of the budget decision, calcium was removed from the PBS for most purposes. It remains listed for patients with renal failure. The PBS includes a wide variety of drugs for many conditions, including bone-strengthening products for certain patients with osteoporosis post-fracture, but it is not possible, and it is not intended, that the PBS cover every useful treatment. ————————— Attachment CALCIUM TABLETS- Deletion from PBS - 2005-06 Budget Decision - Advice to the Minister - July 2005 PBAC meeting 250 mg (as citrate), Citrocal®, Key Pharmaceuticals Pty Ltd; 500 mg (as carbonate), Cal-Sup®, 3M Pharmaceuticals Australia Pty Ltd; 600 mg (as carbonate), Caltrate®, Wyeth Consumer Healthcare. The PBAC noted the policy context of the Budget decision and Government’s view that the Pharmaceutical Benefits Scheme (PBS) does not need to subsidise inexpensive over-the-counter medicines that are required in low doses to obtain health outcomes or where dietary modification could suffice to meet clinical needs. It also noted that the current restricted benefit listing allows for prescribing for hyperphosphataemia in chronic renal failure, hypocalcaemia, osteoporosis, or proven calcium malabsorption. The PBAC recalled that at the June 2005 Special Meeting it had identified the following patient groups where calcium supplementation is clinically necessary.-patients with hyperphosphataemia in chronic renal failure; patients with established osteoporosis and taking bisphosphonates; patients with bone metastases associated with, certain malignancies and taking bisphosphonates; and patients with multiple myeloma and taking bisphosphonates. With respect to use in chronic renal failure, the PBAC again acknowledged that particularly large doses of calcium were required in the treatment of this condition and therefore these patients would be particularly disadvantaged by the de-listing of calcium tablets. The PBAC recalled that the PBS listings for the anti-resorptive agents (including alendronate, risedronate, raloxifene and recently recommended strontium) for established osteoporosis with prior fracture, had been made on the basis that the combination was clinically appropriate, and, when used in combination with calcium, the cost-effectiveness ratio was acceptable. Similarly, the cost-effectiveness of the bisphosphonates in the treatment of bone metastases and multiple myeloma was acceptable on the basis of co-administration with calcium. The PBAC was concerned that these patient groups would not be optimally treated if they ceased taking calcium tablets should they become less affordable by de-listing. The PBAC considered an authority required listing for calcium for the patient groups identified above would ensure that calcium would not be subsidised for dietary supplementation.