Spending on medicines rises even as dispensing drops

Australian prescription dispensing volume is lower, but spending on PBS medicines has increased in the past two years, according to the Australian Institute of Health and Welfare (AIHW)’s biennial report on health information.

Gathered from government and non-government sources covering the health system, population health, and Australian expenditure on healthcare and medicines, the report Australia’s Health 2018 included trends on volume and cost of medicines dispensed under the PBS.

AIHW notes that the medicines available under the Highly Specialised Drugs program (S100) of the PBS account for the majority of the government spending (60%), and that improved recording of such data could account for the rise in expenditure. The information given in this report is given for the period between 2016-17, compared to reports collated since 2006.

The majority of PBS prescriptions were dispensed to people aged 65 and over, peaking in the 80-84 age group. This group also used a relatively higher proportion of hospital and other health services.

Spending on medicines
By volume, more than 280 million prescriptions were dispensed under the PBS and a further 9.3 million dispensed under the Repatriation Benefits Scheme (RPBS), indicating a reduction from the previous period (2015-16) of 2% and 10%, respectively. At an increase of 11% since 2015-16, the Federal Government spent $12.1 billion on all PBS medicines.

Interestingly, in 2015-16, the consumer spend on medicines ($10.8 billion) was equal to the government spend via the PBS ($10.8 billion).

For the current reporting period (2016-17), consumers spent a total of $10.8 billion on medicines, including $1.3 billion on S85 prescriptions priced above the co-payment on PBS medicines, prescription under the PBS co-payment, as well as OTC medicines and private prescriptions in 2015-16.  

The majority of PBS prescriptions were dispensed to people aged 65 and over, peaking in the 80-84 age group. This group also used a relatively higher proportion of hospital and other health services.

Government spending on new medicines under patent included $10 million on pertuzumab for breast cancer and $50 million on pembrolizumab for melanoma, as well as hepatitis C antiviral medicines, medicines for arthritis, and medicines to treat macular degeneration – accounting for the majority of the PBS medicines expenditures.

Australia’s most prescribed drugs
Medicines including statins, and those for the nervous and alimentary systems were the most frequently prescribed in 2016-17 compared to the years 2014-15 and 2015-2016. Notably, prescriptions for medicines to treat excess stomach acid, while only growing slightly in the two previous years, showed greater increase in 2016-17, as dispensing for esomeprazole reached 9 million prescriptions and pantoprazole 6.5 million prescriptions. Three types of antibiotics (amoxicillin, cephalexin, amoxicillin + clavulanic acid) were among the 10 most commonly dispensed medicines.

The prescribing patterns are largely set by GPs, who account for 90% of all PBS medicines prescribing. The highest prescriptions by other clinicians included:

• Medical specialists (other than GPs): latanoprost for high pressure inside the eye, due to glaucoma or other eye diseases; methylphenidate for Attention Deficit Hyperactivity Disorder and narcolepsy.
• Dentists: amoxicillin for bacterial infections.
• Optometrists: fluorometholone for eye conditions due to inflammation or injury; latanoprost for high pressure inside the eye.
• Nurse practitioners: atorvastatin for high cholesterol; esomeprazole for gastric reflux.
• Midwives: cephalexin for bacterial infections.

The report is available to read here.