Australia’s Pharmaceutical Benefits Scheme (PBS) is supposed to make essential medicines affordable for everyone. However, many everyday medications, including painkillers, hormone replacement therapy (HRT), and incontinence treatments, are not subsidized under the PBS. As a result, patients are faced with out-of-pocket expenses that can add up quickly, especially for those with chronic conditions or on fixed incomes.
The Unseen Costs of Private Scripts
Imagine dealing with a long-term health issue, such as incontinence, and knowing that essential medication to help manage your condition is not covered by the PBS. For those affected, this is their reality. While certain medications like oxybutynin are subsidized under the PBS, they often come with side effects that make them unsuitable for many patients, especially older Australians. So, patients often turn to alternatives, but with this comes a high price tag. Some incontinence medications can cost up to $80 a month, which quickly adds up to nearly $1,000 a year.
But it’s not just incontinence treatments. Many HRT therapies and pain relief drugs are also excluded from the PBS, leaving Australians without financial relief for what are often lifelong conditions. The cost of these medicines can range from $20 to $100, but given how frequently they need to be used, these costs add up, placing a significant strain on people’s finances, explains ABC News. The pensioners, those on low incomes, and those living with chronic health conditions are disproportionately affected by these gaps in PBS coverage.
Why Are These Medicines Not Funded?
It turns out that the issue is not necessarily a matter of these drugs failing to meet the scientific or cost-effectiveness standards required for PBS funding. The problem lies with the pharmaceutical companies themselves. According to experts, some companies choose not to apply for PBS listing, as it may not be commercially viable for them. The process of applying for PBS listing can cost companies nearly half a million dollars, a cost that smaller companies are often unwilling or unable to bear, especially when they can charge higher prices for their medicines if they remain off the PBS.
The business side of medicine means that in many cases, companies may make more profit by keeping a drug off the PBS and charging whatever price they want, rather than following through with the lengthy and costly process of submitting their product for PBS consideration. It’s a frustrating and unfair situation for consumers who are left with no choice but to pay high prices for necessary medications.
The Impact on Vulnerable Australians
For those with chronic conditions, this lack of PBS coverage means they must either pay for the medications themselves or go without. The Pensioner Concession Scheme is supposed to offer some financial relief, but if a medication isn’t on the PBS list, even the concession scheme won’t help. This leaves vulnerable groups struggling to access necessary treatments, and some are forced to choose between paying for their medicines or other essentials like food and housing.
Health advocates have long called for a reform of the PBS system, urging the government to do more to ensure that all essential medications are accessible and affordable for all Australians, not just those who can afford private scripts. According to Elizabeth Deveny, CEO of the Consumers Health Forum, these flaws in the system create “huge financial burdens” for patients, particularly those who require multiple long-term treatments.
The Way Forward
There’s hope on the horizon, though. The government has recently started reviewing the PBS system, looking at ways to improve access to more medications, especially in the women’s health sector. With menopause treatments and contraceptives now being added to the PBS list, there’s a growing recognition of the need to provide better access to a broader range of medications.
However, as we move forward, much more needs to be done to address the gaps in the system, especially for commonly used medicines that are left out. Health experts believe that speeding up the PBS approval process and encouraging more small pharmaceutical companies to submit their products for listing could be a step toward a more equitable healthcare system.
In the end, the aim should be to ensure that every Australian—no matter their income or where they live—has access to the medications they need to live healthy, fulfilling lives. If we fail to address these flaws, we risk leaving behind vulnerable populations who depend on affordable, accessible medication for their well-being.
