Programs under section 100 of the National Health Act 1953 enable alternative arrangements to access medicines where these arrangements are considered more appropriate. These include the following programs: Highly Specialised Drugs; Efficient Funding of Chemotherapy; Botulinum Toxin; Growth Hormone; In Vitro Fertilisation (IVF); Opiate Dependence Treatment and Remote Area Aboriginal Health Services. Some medicines covered by s.100 arrangements are restricted to specific conditions, supplied through hospitals, require specialised medical supervision, and/or are high in cost.
In 2017–18, the Highly Specialised Drugs (HSD) and Efficient Funding of Chemotherapy (EFC) programs accounted for 50% and 42% of all accrued expenditure for s.100 programs respectively (Department of Health 2018a).
While government spending on all medicines available through normal PBS arrangements has remained relatively stable, spending on s.100 programs has been increasing—it grew 44% in the 5 years between 2013–14 and 2017–18, which equates to an average annual increase of 9.6%. In contrast, spending on medicines through normal PBS arrangements has increased by 1.5% in total over the 5 years (adjusted for inflation).
The increased cost of the s.100 programs may be due to the steady rise in prescriptions for medicines such as Pembrolizumab (available through the EFC program) and Lenalidomide (available through the HSD program), which are used to treat cancers. Furthermore, the recent introduction of new medicines such as Nivolumab (also used to treat cancers such as melanoma and non-small cell lung cancer) and Sofosbuvir combinations used to treat hepatitis C are a significant source of s.100 program expenditure.
Medicines are primarily prescribed by medical practitioners (GPs and specialists), however certain other types of health practitioners can also prescribe selected medicines.
In 2017–18, GPs prescribed the most PBS and RPBS medicines—around 89% of all prescriptions dispensed. The most commonly dispensed medicines, by authorised occupational group, are outlined in Table 1.
Table 1: Most common medicines by number of prescriptions dispensed, by selected occupational groups, 2017–18
Occupational group
|
Most common medicines
|
Used to treat…
|
GPs
|
Rosuvastatin, Atorvastatin;
Esomeprazole, Pantoprazole
|
High cholesterol;
Gastric reflux and ulcers
|
Specialists
|
Latanoprost;
Methylphenidate
|
Glaucoma and other eye diseases;
Attention deficit hyperactivity disorder
|
Dentists
|
Amoxicillin
|
Bacterial infections
|
Optometrists
|
Latanoprost;
Fluorometholone
|
Glaucoma and other eye diseases;
Eye conditions due to inflammation or injury
|
Nurse practitioners
|
Cefalexin;
Atorvastatin;
Esomeprazole, Pantoprazole
|
Bacterial infections;
High cholesterol;
Gastric reflux and ulcers
|
Midwives
|
Cefalexin
|
Bacterial infections
|
Note: Some medicines may be used to treat a variety of conditions (indications) and this article refers to just some of the common conditions treatable by these medicines.
Source: Therapeutic Goods Administration, Consumer Medicines Information (CMI) and Product Information (PI) documents for selected medicines.
In 2017–18, PBS prescriptions were dispensed to 17.0 million Australians (69% of the population). Population dispensing rates increased with age—young people aged 0–14 had the lowest rates of dispensed prescriptions (173 per 100 people), and the highest rates were among those aged 85 and over (6,077 prescriptions per 100 people). Similar patterns were seen for both males and females (Figure 4).
Over half of PBS and RPBS medicines were dispensed to people aged 65 and over (53%). Within specific age groups, people aged 65 to 74 had the highest number of dispensed prescriptions and accounted for the highest Australian Government expenditure.
When adjusting for the difference in population age structure, the overall rate of dispensed prescriptions fell slightly (3.5%) between 2013–14 and 2017–18 from 1,137 to 1,097 prescriptions per 100 population (Figure 1). This was particularly the case for above co-payment prescriptions, where age-standardised dispensing rates per 100 people fell 11% (from 847 to 754 per 100 people).
The fall in subsidised prescription rates occurred for all age groups with the exception of those aged 85 and over. It was most apparent for the 55–64 age group, for which the age-specific prescribing rate fell 16%, and the 0–14 age group with a 13% fall. This is at least in part due to the reduction in cost for medicines leading to more scripts to fall under the patient co-payment amount. This flow on effect results from various factors including the introduction of generic medicines onto the PBS and other Australian Government measures focussed on the sustainability of the PBS.