THE IMPACT OF PHARMACEUTICAL BENEFITS SCHEME REFORMS ON DISPENSING OF STATINS MEDICINES IN AUSTRALIA FROM 1992 – 2011

Purpose: Pharmaceutical Benefits Scheme (PBS), a key component of Australia's health system subsidises the cost of medicine for most medical conditions for all Australian residents. In the past 20 years, the Australian Government has implemented several cost containment measures to curb the increases in the PBS expenditure. The purpose of this study was to investigate the impact of these reforms on dispensing (service) of statins or HMG-CoA reductase inhibitors medicines, the most widely dispensed medicines in the PBS.

Method(s): Monthly statins service data were retrieved from Medicare Australia’s PBS Statistics database. Segmented linear regression models were used to analyse the time series data starting from 1 January 1992 to 31 March 2012. Six cost containment measures (re-supply limits, two co-payment increases, therapeutic group premium (TGP) policy, safety net 20-day rule, and price reductions in multiple brand drugs in Formulary 2) and four new listing dates of statins (Pravastatin, Fluvastatin, Atorvastatin, and Rosuvastatin) on the PBS  break the time series into segments. In each segment, two parameters, the level and trend were used to estimate the impact of the intervention. To adjust for seasonality and to obtain a parsimonious model, a 12 months lag and forward stepwise eliminations were applied.

Result(s): Out of the six containment measures, the reductions in both the services level and trend were observed in the safety net 20-day rule. However, the reductions in the level alone were observed for two co-payment increases and the listing of Fluvastatin while trend reductions were observed in TGP policy, price reductions and the listing of Atorvastatin. The listing of Pravastatin and Rosuvastatin were found to have no significant impact on statins services. In contrast, there were increases in the services level after the implementation of price reduction while the re-supply limits measure and the listing of Fluvastatin increased the services trend.

Conclusion(s): Overall, there were reductions in statins utilisation in either level and/or trend for all cost containment measures except for the re-supply limits measure. Among those measures, the safety net 20 days rule was found to be the most effective in reducing statins utilisation with the trend in services reduced after its implementation in addition to initial decrease in level.