Your questions to the PBAC

Sir, Why are sodium cromoglycate eye drops listed as an 'authority required' item? Surely it can't be because of the cost. I can't believe that it would be due to safety considerations either, when one sees that prednisolone eye drops are available as an unrestricted benefit.

Geoffrey L. Campbell
General Practitioner
Warragul, Vic.

When considering an application for the listing of Opticrom (sodium cromoglycate eye drops) as a pharmaceutical benefit, the Pharmaceutical Benefits Advisory Committee sought advice from the Royal Australian College of Ophthalmologists. The College's view was that, while these eye drops had been found to be useful for long term prophylaxis in patients with vernal conjunctivitis, use in generalised allergic conjunctivitis was thought to be both unnecessary and unhelpful.

Since that time, the PBAC has considered and rejected applications to derestrict this item. The Committee remains of the view that the current 'authority required' listing is appropriate.

Sir, In the list of 'Top 10 drugs' (Aust Prescr 1994;17:69), it is stated that the cost of glyceryl trinitrate to the government in 1992 was $27 774 725.

Could the cost be reduced if glyceryl trinitrate were dispensed in small quantities for those who need to carry it for only occasional use?

This would apply to some patients as well as medical staff carrying it for emergencies. As the drug must be discarded 3 months after opening, sachets containing a few tablets (e.g. 10) would reduce wastage.

Janet D. Fitzpatrick
Medical Practitioner
Carlton, Vic.

The figure of nearly $28 million quoted as the cost to government for glyceryl trinitrate during 1992 refers to all the drug's forms and strengths that are listed on the Pharmaceutical Benefits Scheme. This includes more expensive and stable preparations such as the buccal/sublingual spray, ointment and transdermal discs/patches as well as the traditional 600 microgram tablet. These tablets represent only a small proportion (about 6.5%) of the annual expenditure for the drug on the Scheme.

The Pharmaceutical Benefits Advisory Committee has previously considered and rejected requests to reduce the maximum quantity applying to the listing of glyceryl trinitrate tablets in the Schedule of Pharmaceutical Benefits. The Committee recognised that there may be instances where patients do not require as many as 100 tablets, but it was considered that the minimal cost savings achieved by reducing the maximum quantity does not warrant the inconvenience or potential danger to patients who use the drug more frequently.

Furthermore, in this particular case, the cost of the drug is relatively small compared to the manufacturing and packaging costs. Thus, there would be minimal savings if glyceryl trinitrate tablets were packaged in smaller quantities and the availability of a smaller pack in addition to the 100 would mean unnecessary additional space in pharmacy dispensaries and wholesalers' shelves.