Review backs overhaul of PBS chemotherapy funding


By Geir O'Rourke

7 Sep 2023

Reforms are needed in the PBS Efficient Funding of Chemotherapy program to improve equity of access and reduce red tape for clinicians, a federal health department-commissioned review has found.

Led by former Cancer Council CEO Professor Sanchia Aranda, the review also called for a name change and stakeholder education on the scheme, which funds $2 billion in cancer drugs annually and accounts for about one tenth of total PBS expenditure.

It found by and large, the program “continues to be an appropriate policy response for the specialised nature of cancer care”, covering 1.39 million PBS claims in 2020-21 – mostly infused and individually compounded cancer drugs.

But there was room for improvement, with funding inconsistencies across jurisdictions, between public and private hospital patients and in co-payment arrangements for ancillary drugs, according to the reviewers.

They said clinicians found the arrangements for access to medicines on the program to be “overly complex and associated with high administrative burden”.

Much of this burden surrounded the need for written authority and subsequent restrictions on doctors’ ability to prescribe the required dose on a per-patient basis.

The scheme was also subject to different red tape to the rest of the PBS, which increased the administrative challenge for clinicians, they said.

To address this, the reviewers recommended education for all stakeholders on the basis for PBAC recommendations on cost-effectiveness “including how PBS authority and listing requirements support the principles of cost-effectiveness”.

The program should also be expanded to include all compounded cancer medicines listed for cancer indications on the PBS, they wrote.

Beyond this, patient access was a major concern, with current co-payment arrangements resulting in”some disparities for cancer patients depending on whether they access care via a public or private hospital setting, or whether they are accessing supportive cancer medicines”, according to the review.

It added: “The review recognises the critical nature of ensuring access to quality care for patients living outside of metropolitan areas; current arrangements for the funding and provision of cancer medicines may result in delays in access for patients in rural/remote areas, or increased ‘costs’ in order to access care.”

Removing the distinction between public and private hospital prescribing under the program would eliminate differences in out-of-pocket costs to patients based on setting in which prescribers are authorised, the reviewers said.

Distinctions between medicines listed under Schedule I and Schedule II of the scheme would also ensure patients were not differently affected by co-payments, they added.

Another issue identified in the review was a gradual shifting in focus of the scheme from cytotoxic cancer medicines towards immunotherapies and other targeted treatments.

The authors stressed that while cytotoxic chemotherapies continued to account for the majority of services via the EFC, they now comprised less than 10% of the overall benefits paid through this program.

Due to the less onerous safety requirements associated with compounding of non-cytotoxic medicines, this had prompted an increase in the use of third-party private sector compounders which had improved capacity of some smaller hospitals to provide cancer medicines closer to home, but had also led to a reduction in public sector capacity, they said.

To reduce waste, the current prohibition vial sharing should be overturned, while reimbursement of drugs should be on a per-mg basis, which would reduce the extent of ‘double-payment’ for drug wastage, they added.

Releasing the report on 1 September, the Department of Health and Aged Care said it undertake further consultation with regards to the recommendations to ensure continued and improved access to safe, high-quality cancer medicines in Australia (link here).

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