Easier Prescriptions?

The Pharmaceutical

Benefits Advisory Committee will consider loosening the prescribing authority for PBS-listed hepatitis C medicines, but the real focus seems to be on securing a price reduction for the government. The Department of Health notified companies that make the reimbursed direct-acting antivirals (DAAs) in writing in late February that the issue would be considered at the PBAC’s March meeting. The Committee will consider the potential loosening of the authority level from ‘authorityrequired’ to ‘streamlined’. This would make DAAs quicker and easier for doctors to prescribe. The letters arrived just days after a stakeholder roundtable was convened to discuss the current usage rates of the cures, including the concerning decline in uptake (see our story in issue 82, online at issuu.com/hepccsa/docs/ hcn82/12). Online industry website BioPharmaDispatch (pharmadispatch.com) first reported the story, and stated that during the roundtable stakeholders did not focus on the authority as a barrier to uptake. It is unclear the extent to which changing the authority level would improve the uptake of the DAA therapies. But the Federal Government would benefit from an increased uptake because of the existing agreements with DAA manufacturers. Under the agreement, which expires in early 2021, the per-patient cost falls if uptake and spending on the therapies rise above specified caps, as more people are cured at a lower per-patient cost. Lower utilisation means higher per-patient cost. However, while changing the authority level may not lead to an increase in uptake with the potential lower per-patient cost, the federal government would immediately lock in a saving from any related price reduction. The utilisation of the therapies surged when they were first added to the PBS in early 2016. However, it subsequently fell, with monthly new patients starting treatment hovering at or below 1,000 nation-wide for most of the past two years. The Australian Chief Medical Officer, Professor Brendan Murphy, told BioPharmaDispatch in 2018 that achieving the goal of eliminating hepatitis C by the target date of 2030 requires 1,500 to 2,000 new patient initiations every month. (NB: see p13 for further positive PBS developments.) v