Palliative care services in Australia

Pharmaceutical Benefits Scheme and Repatriation Pharmaceutical Benefits Scheme data

Services Australia (formerly the Australian Government Department of Human Services) collects administrative data in processing prescriptions dispensed under the Pharmaceutical Benefits Scheme (PBS) and Repatriation Pharmaceutical Benefits Scheme data (RPBS) and provides these data to the Australian Government Department of Health and Aged Care.

Through the PBS and RPBS data, the Australian Government subsidises the cost of pharmaceutical products listed on the Schedule of Pharmaceutical Benefits (Department of Health and Aged Care 2023). In 2004, the Australian Government introduced Pharmaceutical Benefits for Palliative Care, referred to as the PBS Palliative Care Schedule. The PBS Palliative Care Schedule, which lists medication items available for palliative care, was established as a separate schedule, complementing the General Schedule to improve access to essential and affordable medications for patients receiving palliative care.

Palliative care patients who are accessing medications listed in the PBS Palliative Care Schedule can also access medications listed on the General Schedules, for example morphine. The same medications may be listed on the PBS Palliative Care Schedule and the General Schedule, however, medications on the PBS Palliative Care Schedule may be listed with larger quantities and/or more script repeats, making them more suitable for use in palliative care (Department of Health 2016a). This may reduce patient co-payment costs and decrease the frequency of doctor consultations for ongoing symptom management. Given the overlap in medication items listed on the different schedules, and because the PBS Palliative Care Schedule is intended to complement the General Schedule, it is likely that some medicines prescribed for palliative care are prescribed from the General Schedule. These prescriptions are not included in the count of palliative care-related prescriptions in this report. In addition, medications prescribed for palliative care purposes in some other instances are not included in this report as well, since PBS and RPBS data do not capture over the counter medicines, medicines supplied to public hospital inpatients, and private prescriptions. For example, if a medicine is not listed under the PBS Schedule for a specific indication, but it has market authorisation by the Therapeutic Goods Administration for sale, it would not be included.

Palliative care prescriptions can also be identified through the prescriber. Palliative medicine specialists may prescribe medicines for a range of reasons, some of which may be for palliative care, and may prescribe from different schedules. This report includes information on medications prescribed by palliative medicine specialists from all schedules (Table 8 in Data tables for Palliative care-related medications) and are therefore likely to include prescriptions prescribed for both palliative care and non-palliative care reasons. 

In summary, only the medications listed on the PBS Palliative Care Schedule (referred to as palliative care-related prescriptions) and the medications prescribed by palliative medicine specialists are included in this report. 

The PBS and RPBS data presented in this report (2022–23 and trend data) are based on the date of supply, that is when the prescription was dispensed to the patient.

Types of palliative care-related prescriptions

Previously, this report has defined types of palliative care-related medicines by categories based on the Anatomical Therapeutic Chemical (ATC) classification system (WHO 2022). Since 2022, this report has used an updated method to report types of palliative care-related prescriptions, with the categories based on the Palliative Care publication of the Australian Therapeutic Guidelines (Therapeutic Guidelines Limited 2021). Therefore, the medication types (at the ATC level 2) in editions before 2022 are not directly comparable with the ‘medication group’ in this report. 

Table 3 lists the medication items from the PBS Palliative Care Schedule with their corresponding medication groups and ATC codes at levels 2, 3 and 5. Note that most of these medicines are listed in multiple areas in PBS and RPBS, and are not specific to the Palliative Care Schedule. In this report, data extracted using ATC codes for medication groups was filtered by program type (Palliative Care Schedule) to report on all palliative care-related prescriptions.

*Hyoscine Butylbromide can also be used to manage respiratory secretions.

**These PBS items are listed on the PBS as Restricted Benefit which can only be prescribed for specific therapeutic uses.

Relevant changes to the Pharmaceutical Benefits Scheme and Repatriation Pharmaceutical Benefits Scheme over time

Reporting of ‘subsidised’ and ‘under co-payment’ prescription data

Under the PBS and RPBS, the Australian Government sets a maximum ‘patient co-payment’ amount that people pay towards the cost of their medicines. 

• If a prescription is priced over the co-payment threshold, it is considered as ‘over co-payment’ or a 'subsidised prescription', the Australian Government pays pharmacies the difference between a consumer’s co‑payment and the PBS price of a medicine, as listed on the Schedule of Pharmaceutical Benefits.
• If a prescription is priced below the co-payment threshold, it is classified as an ‘under co-payment prescription’, the consumer pays the total cost, and the government does not contribute.

The maximum co-payment a patient pays depends on their level of entitlement, which is determined by the patient’s concessional status and whether they have qualified for the PBS safety net. Current and historical co‑payments can be found on the PBS website.

Until 1 April 2012, PBS and RPBS prescription data supplied to the AIHW by the Department of Health and Aged Care excluded prescriptions costing less than the patient co-payment amount (under co-payment). 

From 1 April 2012, changes to the National Health Act 1953 required pharmacies to supply data for prescriptions that are priced below the patient co-payment level to Services Australia (Department of Health and Ageing 2011). Under co-payment prescription data were then supplied in PBS and RPBS Palliative Care data sets and were incorporated in the same tables as subsidised prescription data but were often reported separately. 

Since 2022, this report combines under co-payment and subsidised data in most tables. An additional table by patient beneficiaries shows the palliative care data by co-payment type in a single table for 2022–23 (Table 4 in Data tables for Palliative care-related medications), rather than including this split in every table.

Changes to restriction levels on the Palliative Care Schedule

On 1 June 2016, as part of the Post-market Review of Authority Required PBS Listings, changes were made to items listed on the Palliative Care Schedule. The restrictions for a number of Palliative Care Schedule items were changed and some medications were added or deleted. The restriction level of certain Palliative Care Schedule items, specifically those in the ‘pain relief’ and ‘gastrointestinal symptoms’ categories, were changed, in many cases from ‘Authority Required (STREAMLINED)’ to ‘Restricted Benefit’, reducing the level of restriction. Certain versions of medications were delisted due to initial and continuing treatment restrictions being simplified and merged under a single item code. Prescriptions written prior to 1 June 2016 for deleted item codes remained valid for a 12-month transition period. Some pain relief items were also added, specifically Buprenorphine, resulting in an increase in prescriptions in this category.

It should also be noted that data from 2016–17 onwards are not comparable with previous years. This is due to significant changes to the PBS restriction level from June 2016, as well as new listings of medications in the PBS Palliative Care Schedule (Department of Health 2016b). These changes particularly affect medications in this report that come under the ‘pain relief’ and ‘gastrointestinal symptoms’ categories. 

References

Department of Health and Aged Care (2023) Schedule of Pharmaceutical Benefits: Summary of Changes. Effective 1 January 2023, Department of Health and Aged Care, Australian Government, accessed 10 January 2023.

Department of Health (2016a) Access to medicines for palliative care on the PBS, Department of Health, Australian Government, accessed 20 January 2023. 

Department of Health (2016b) Schedule of Pharmaceutical Benefits: Summary of Changes. Effective 1 January 2016, Department of Health, Australian Government, accessed 10 January 2023.

Department of Health and Ageing (2011) Pharmaceutical Benefits Scheme Collection of Under Co-payment Data, Department of Health and Ageing, Australian Government, accessed 10 January 2023.

Therapeutic Guidelines Limited (2021) Therapeutic Guidelines: Palliative Care, Therapeutic Guidelines Limited website, accessed 10 March 2023.

WHO (World Health Organization) (2022) ATC Structure and principles, WHO website, accessed 18 January 2023.