In a recent article Dr Tatchell gives a comprehensive review of the pricing of prescription medicines (Aust Prescr 2009;32:6-8). While he addresses issues in the community setting, he fails to include the complexity of prescription pricing in public hospitals.
Access to Pharmaceutical Benefits Scheme (PBS) dispensing was introduced into public hospitals in 2002. While this was intended to parallel the structure in community dispensing, some pricing anomalies exist. Brand price premiums, therapeutic group premiums and special patient contributions do not generally apply. Safety net contributions also differ. Any patient co-payment is added to the patient's safety net, whether for PBS or non-PBS subsidised items. In some hospitals, patient co-payments for non-PBS items are capped at the patient co-payment contribution rate. For example, concession patients pay no more than $5.30 per item, and safety net exemption cardholders may find they are not charged for non-PBS items or even over-the-counter items.
The availability of chemotherapy under the Chemotherapy Pharmaceuticals Access Program1 adds another layer of complexity. Patients can access PBS-subsidised chemotherapy under this program. While they do not pay a co-payment, the actual dollar value of the co-payment (for example, $5.30 per concession patient) is still added to their safety net.
In this era of continuum of care, patients need to be aware that pricing structures differ between the hospital and community setting. Physicians who work in both the public and private sectors must also have an understanding of this pricing anomaly.
Jim Siderov
Senior Pharmacist, Cancer Services
Robert Mc Lauchlan
Dispensary Manager
Austin Health
Heidelberg, Vic.
