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Special payments for some PBS medicines.



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MEDIA RELEASE Minister for Health and Ageing

Tony Abbott MHR 15 June 2005 ABB075/05

SPECIAL PAYMENTS FOR SOME PBS MEDICINES

In March this year the pharmaceutical industry agreed that new generic medicines entering the Pharmaceutical Benefits Scheme (PBS) after 1 August would list at 12.5 per cent below the current benchmark price.

Through the operation of standard reference pricing arrangements, a new listing at a reduced price means that drugs in the relevant reference price group would be reduced in price by 12.5 per cent.

The Government is now in the process of implementing 12.5 per cent price cuts for 10 brands of PBS medicines where generic equivalents have applied for listing on August 1.

Unfortunately, four companies have not agreed to accept lower prices. As a result four brands of medicines listed on the PBS will be subject to a Special Patient Contribution in addition to the normal PBS co-payment.

For these medicines the difference between the existing price for the drug and the new benchmark price will become a Special Patient Contribution (SPC). SPCs are normally paid by the patient in addition to the relevant co-payment (currently $4.60 for concessional patients and $28.60 for general patients).

The Government is confident, based on expert advice, that medicines in the same reference pricing group can usually be safely substituted for one another. There should be an alternative medicine that can be prescribed for patients whose current medicine will attract an SPC from August 1.

Even so, where the prescribing doctor believes there is no clinically appropriate alternative, the government will pay the Special Patient Contribution on behalf of the patient. The patient’s prescribing doctor will be able to seek an authority from the Health Insurance Commission to waive the Special Patient Contribution and the government will pay the premium. Special patient contributions will not apply to prescriptions written before 1 August 2005 and supplied up to1 March 2006.

Further information on the 12.5 per cent policy can be found at http://www.health.gov.au/internet/wcms/publishing.nsf/Content/health-pbs-pricereductions

Media contact: Kate Miranda, 0417 425 227