Aniello Iannuzzi: Simple remedy

THE Abbott government wants to make spending cuts across the board. In health this is especially pertinent because of an ageing population and the need to fund new treatments.

Doctors were nonplussed with the previous government’s decision to freeze Medicare rebates until July next year. So far, the new Health Minister Peter Dutton has not reversed the decision.

Pharmacists were also up in arms about a reduction in the price of many commonly prescribed drugs under the Pharmaceutical Benefits Scheme (PBS).

One way the government could reduce the cost of the PBS is to attack the inefficiency of PBS pack sizes and listings.

A common complaint from patients is the confusion and inconvenience created by different pack sizes as they attempt to manage medications. This same complaint is echoed by pharmacies and nursing homes.

In terms of medicines intended for long-term use, the main inconsistency relates to many packs having 30 doses, while others have 28. It may not seem like a big issue, but as the months tick along the medications get out of sync for the patients, resulting in many GP visits just for script renewals.

For instance, statin drugs are in packs of 30, but common antihypertensives are in packs of either 28 or 30. Diuretics are usually in larger packs (eg, frusemide comes in packs of 100), so for many patients one repeat can last for several months.

One pack of aspirin on the PBS lasts for almost 3 months, yet clopidogrel lasts for one.

Antibiotics are another area of inefficiency. The new antibiotic guidelines for simple urinary tract infections (UTIs) in women suggest 3 days of trimethoprim — the PBS pack is seven tablets. Considering UTIs most commonly occur in adult females, wouldn’t a smaller pack make more sense, not to mention save taxpayers a lot of money?

And what about all those antibiotics we want to prescribe for a week, when the pack only allows for 5 days? Doxycycline comes in a number of different pack sizes on the PBS — it is high time some other antibiotics offered such flexibility too.

The standard issue for a strong paracetamol–codeine combination (eg, Panadeine Forte) is 20 tablets, meaning that the standard dose of two tablets three or four times a day allows for the packet to last no more than 4 days. In contrast, oxycodone preparations are in pack sizes designed to last longer.

How is that inconsistency explained given the expense of the oxycodone and its reputation as a drug of addiction and illicit trade?

The future of many cheaper drugs on the PBS should also be scrutinised. The best examples here are aspirin, paracetamol and iron supplements. Patients prescribed these drugs often tell us it is cheaper to buy them over the counter rather than on prescription, even with a pensioner discount.

So if a patient can buy a pack of 100 paracetamol tablets over the counter for as little as $2, why does the PBS pay pharmacies a wholesale price, profit margin and dispensing fee amounting to closer to $8?

It may be impossible to accurately quantify, but I bet that there are thousands of unnecessary GP visits per year — paid for by Medicare — for no other reason than to iron out discrepancies in prescriptions.

A simple solution is to allow doctors more flexibility in prescribing, so that pack sizes are not such a big determinant of prescription quantity and repeats.

Many long-term drugs should be dispensed in 3-month or 6-month quantities without the need to contact PBS authorities.

The reduction in doctor visits and pharmacy dispensing fees would surely make this an ideal way for the new government to rein in health costs.

Dr Aniello Iannuzzi is a GP practising in Coonabarabran, NSW.