Outcome 2 – Access to Pharmaceutical Services

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Outcome Strategy

This chapter reports on the major activities undertaken by the department during the year, reporting against each of the major activities and performance indicators published in the Outcome 2 chapter of the 2010-11 Health and Ageing Portfolio Budget Statements (PB Statements) and the 2010-11 Health and Ageing Portfolio Additional Estimates Statements (PAES). It also includes a table summarising the estimated and actual expenditure for this Outcome.

Outcome 2 was managed in 2010-11 by the Pharmaceutical Benefits Division.

Program Name	Program Objectives in 2010-11
Program 2.1: Community Pharmacy and Pharmaceutical Awareness	Support timely access to medicines and professional pharmacy services through the implementation of the Fifth Community Pharmacy Agreement. Support quality use of medicines for Aboriginal and Torres Strait Islander peoples, through education and targeted support for consumers and health professionals.
Program 2.2: Pharmaceuticals and Pharmaceutical Services	Manage the Pharmaceutical Benefits Scheme (PBS) including gaining better value from competition between brands of medicines listed on the PBS. Improve health outcomes and sustainability of the PBS by improving the evidence base for prescribing decisions and the assessment of effectiveness of listed PBS medicines. List cost-effective new, innovative, clinically effective medicines on the PBS. Improve community access to a range of pharmaceutical benefits when prescribed by appropriately trained and certified nurse practitioners and midwives.
Program 2.3: Targeted Assistance – Pharmaceuticals	Improve access to new and existing medicines for patients with life threatening conditions.
Program 2.4: Targeted Assistance – Aids and Appliances	Increase the affordability of insulin pumps and associated consumables for children under 18 years of age with type 1 diabetes. Continue to assist people with a stoma by providing free stoma related products. Ensure continued access to necessary and clinically appropriate dressings, and improve the quality of life for people with Epidermolysis Bullosa.

Major Achievements

• Developed the Community Pharmacy Service Charter and Customer Service Statement. To be displayed in pharmacies from 1 July 2011, they will provide consumers with a better understanding of the types and level of service they can expect to receive at their pharmacy.
• Implemented Further Pharmaceutical Benefits Scheme Reforms.
• Listed 142 new PBS medicines or extensions to existing PBS listed medicines, with a total value of $439.9 million over five years. The PBS medicines included azacitidine for the treatment of certain types of Leukaemia and extension of the listing of nicotine patches for smoking cessation. In addition, one medicine was included on the Life Saving Drugs Program (LSDP) with a total value of $135.9 million over five years.
• Continued access to National Diabetes Services Scheme for more than one million Australians with diabetes following successful negotiations with Diabetes Australia to improve services and information under the scheme for a further five years.

Challenges

• Monitoring the changing pharmaceutical wholesaling environment to ensure continued timely
  access to PBS medicines by the Australian community.
• Administering the listing of new items on the PBS and Life Saving Drugs Program within revised
  approval processes.

Trends

Figure 2.4.2.1: Government PBS expenditure and cost per capita, 2007-08 to 2010-11

Text version of this chart

Note: The Australian population figures used to derive the per capita estimates are based on Australian Bureau of Statistics publication 3101.0.

Program 2.1: Community Pharmacy and Pharmaceutical Awareness

Fifth Community Pharmacy Agreement

Qualitative Deliverable:	Implement revisions to professional programs and services under the Fifth Community Pharmacy Agreement.
2010-11 Reference Point:	Establish the Programs Reference Group and agreement on revisions for new and existing programs and services.
Result: Deliverable met.
The Programs Reference Group was established and Terms of Reference agreed at its first meeting in December 2010. The Programs Reference Group members, with broad expertise in the health care sector, met three times and provided substantial policy input to the design, operation and evaluation of programs under the Fifth Community Pharmacy Agreement. Nine existing programs are continuing under the Fifth Community Pharmacy Agreement, with enhancements to improve targeting and accountability. Three of the six new programs started from 1 July 2011 and a further three will start from 1 July 2012.

As part of the Agreement, and in consultation with consumers, carers and other groups, the department and the Pharmacy Guild of Australia have developed a Community Pharmacy Service Charter.²⁵ Based on the Australian Charter of Health Care Rights, the Community Pharmacy Service Charter seeks to empower consumers through providing information on their rights as well as the responsibilities of pharmacists in delivering quality services and professional care. The Charter covers a number of areas such as access and participation and informing consumers of their rights in terms of making decisions around their medicines. The Charter further allows patients, consumers, families, carers and community pharmacies to have a shared understanding of the rights of people receiving health care.

A Customer Service Statement has also been developed in conjunction with the Charter. This Statement is prepared by individual pharmacies to provide consumers with information about the pharmacy and the professional services it offers.

From 1 July 2011, community pharmacies must display and adhere to both the Charter and Customer Service Statement to access new Pharmacy Practice Incentives.

Qualitative Deliverable:	Develop and implement a Patient Service Charter framework.
2010-11 Reference Point:	In consultation with key stakeholders, develop a Patient Service Charter that is agreed for use by community pharmacies.
Result: Deliverable met.
The department developed a Community Pharmacy Service Charter and Customer Service Statement in consultation with key stakeholders. The Community Pharmacy Service Charter is based on the Australian Charter of Health Care Rights developed by the Australian Commission for Safety and Quality in Health Care in 2008 and was adapted to the community pharmacy setting. The department consulted with consumers, carers and relevant stakeholders between December 2010 and March 2011. The agreed Charter and accompanying information for pharmacies and consumers were distributed in June 2011.

The Pharmacy Practice Incentives Program will improve patient health outcomes in three priority areas and also introduce three new programs formalising existing services such as clinical interventions, aids for administering doses of medicines, and staged supply of medicines when it is in the patient’s best interest. The Program was officially launched in March, and over 4,000 community pharmacies registered to participate by June 2011.

During 2010-11, the department enhanced two existing medication management programs. The Home Medicines Review Program will be more accessible from 1 October 2011 when general practitioners can directly refer patients to accredited pharmacists, in addition to current arrangements which allow referrals to a community pharmacy. Also from 1 October 2011, collaboration will be required between pharmacists and general practitioners when providing Residential Medication Management Reviews to residents of aged care facilities. These programs continued to provide benefits by reducing the risk to the community of medicine misadventure and related hospital admissions.

During 2010-11, the department developed an assessment tool for a pilot of two new in-pharmacy medication review services: MedsCheck and Diabetes MedsCheck. Findings from the pilot will support a national rollout of the MedsCheck and Diabetes MedsCheck services from 1 July 2012.

Qualitative Deliverable:	Provide funding to community pharmacies to support the delivery of professional programs and services.
2010-11 Reference Point:	Community pharmacies in rural and remote areas access funding to support the delivery of medication management services.
Result: Deliverable met.
In 2010-11, almost 3% of Home Medicines Reviews were conducted in remote areas, indicating that community pharmacies in these areas are accessing funding to support the delivery of medication management services. Pharmacies also continued to access the rural loading payment for travel for the Home Medicines Review Program, indicating that there has been sustained effort towards providing services to people in rural and remote areas. Under the Rural Pharmacy Workforce Program, pharmacists in rural and remote Australia received assistance to access professional education, locum services, and pharmacist intern placements. The Aboriginal and Torres Strait Islander Workforce Program provided approved Aboriginal and Torres Strait Islander students with access to 23 Pharmacy Assistant traineeships and three undergraduate or postgraduate Pharmacy scholarships. The program strengthened Aboriginal and Torres Strait Islander participation in the pharmacy workforce, which in turn provided improved, culturally appropriate pharmacy services to better meet the needs of their local Indigenous communities and patients.
Quantitative Deliverable:	Number of medication management services provided under the Fifth Agreement.
2010-11 Target:	60,000	2010-11 Actual:	61,353
Result: Deliverable met.
The Home Medicines Review Program met and exceeded the target of 60,000 reviews. The increased uptake of the program indicates that more patients could access services to help them better manage their medicines, reducing the risk of a medicine related adverse event occurring. In addition, the Residential Medication Management Review Program resulted in 137,569 reviews provided to residents of Commonwealth funded Residential Aged Care facilities.

The Community Service Obligation arrangements continued under the Fifth Community Pharmacy Agreement ensure all Australians have timely access to PBS medicines, regardless of location. In 2010-11, a new five year agreement for wholesale distribution of PBS medicines was signed with five full-line pharmaceutical wholesalers and enhanced arrangements from the previous agreement. Under these arrangements, Community Service Obligation wholesalers continue to be financially supported to stock and supply PBS medicines within 24 hours to pharmacies nationally. This was done against the background of evolving distribution networks for PBS medicines.

As a result of the severe Queensland floods in January 2011, arrangements were put in place in flood affected areas to assist Queensland residents who had lost their medication and/or prescriptions. The department collaborated with Medicare Australia, the Pharmacy Guild of Australia and Community Service Obligation distributors to ensure that Queensland residents had continued access to PBS medicines. This included extending existing arrangements to facilitate quick approvals for community pharmacies to trade from new temporary premises, where required, and advising pharmacists of arrangements to allow immediately dispensing of medicines to affected patients.

Qualitative Deliverable:	Map Pharmacy Accessibility and Remoteness Index to new Australian Standard Geographic Classifications to support shift to new funding model for rural pharmacy programs.
2010-11 Reference Point:	Mapping to new geographical classifications completed by 30 June 2011.
Result: Deliverable substantially met.
The Australian Government announced in the 2009-10 Budget that, under the Rural Health Package, the majority of rural health programs which use remoteness classifications would move to the new Australian Standard Geographic Classifications – Remoteness Area. The department, in consultation with the Pharmacy Guild of Australia, commenced modelling work during 2010‑11 to identify appropriate options for a transition to the Australian Standard Geographic Classification – Remoteness Area. However, the progressive implementation of a new Australian Geography Standard has been scheduled for commencement from July 2011 by the Australian Bureau of Statistics. This development necessitates further modelling to achieve appropriate transition arrangements for Fifth Community Pharmacy Agreement programs.
Quantitative KPI:	Percentage of rural community pharmacies accessing targeted programs to ensure accessibility of community pharmacy in rural and remote Australia.
2010-11 Target:	60%	2010-11 Actual:	83%
Result: Indicator met.
During 2010-11, programs supporting community pharmacy in rural and remote Australia were well accessed. The Rural Pharmacy Maintenance Allowance supports 83% (776 of 926) pharmacies in rural and remote areas, based on their geographical classification under the Pharmacy Accessibility and Remoteness Index of Australia. The Rural Pharmacy Maintenance Allowance Program aims to ensure people in rural and remote areas can access PBS medicine through supporting access to Australia’s rural and remote pharmacy network. It provides income support to pharmacies in rural and remote areas. This recognises the additional financial and personal cost of operating in these areas. A total of 30 Indigenous Pharmacy Assistant traineeship placements (12 continuing from the Fourth Community Pharmacy Agreement) and 10 Indigenous Pharmacy scholarships (seven continuing from the Fourth Community Pharmacy Agreement) are currently active.

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Improve Access to PBS for Aboriginal and Torres Strait Islander Peoples

During 2010-11, the department continued the Quality Use of Medicines Maximised for Aboriginal and Torres Strait Islander Peoples Program that commenced in November 2008 as a trial. In 2010-11, over 192,000 eligible Aboriginal and Torres Strait Islander patients registered with Aboriginal Community Controlled Health Services and received quality use of medicines support. An independent program evaluation, released in June 2011, found the program was successful in achieving key program objectives of improving access to PBS medicines, and supporting medication compliance and quality use of medicines for Aboriginal and Torres Strait Islander peoples in rural and urban areas of Australia.

Quantitative Deliverable:	Number of patients issued a Closing the Gap prescription through the PBS Co‑payment Measure under the Indigenous Chronic Disease Package.
2010-11 Target:	20,000		2010-11 Actual:		79,076
Result: Deliverable met.
Uptake of the PBS Co-payment Measure has been higher than anticipated, significantly exceeding the target of 20,000. In 2010-11, 79,076 patients were issued with a Closing the Gap prescription. The average number of additional patients per month assisted under the measure for the last ten months of 2010-11 was 6,200. This growth rate is expected to continue for at least several more months due to the ongoing promotion of the measure to general practitioners, Aboriginal Health Services and pharmacists. The positive uptake of the measure indicates higher than expected awareness of this measure by prescribers resulting in eligible patients receiving access to more affordable PBS medicines to manage chronic disease.
Qualitative KPI:	Successful implementation and uptake of the Subsidising PBS Medicine Co-payments Measure by community pharmacies.
2010-11 Reference Point:	Uptake of claims from 1 July 2010, and stakeholder satisfaction with the Measure.
Result: Indicator met.
All dispensing software was upgraded with Closing the Gap processing functionality. This measure has reduced the cost of PBS medications for many Indigenous Australians. Feedback from stakeholders indicates that they recognise the significant benefits resulting from the introduction of the measure. A total of 827,493 PBS prescriptions were dispensed from 3,694 community pharmacies under this measure.
Qualitative KPI:	Improved management of medicines for Aboriginal and Torres Strait Islander patients.
2010-11 Reference Point:	Overall evaluation of the Indigenous Chronic Disease Package indicates that the Subsidising PBS Medicine Co-payments Measure has contributed to these outcomes.
Result: Indicator met.
The Sentinel Sites Evaluation Report – December 2010 indicates that stakeholders believe access to cheaper PBS medication often translated into medications being taken more readily by Aboriginal and Torres Strait Islander patients.
Quantitative KPI:	Percentage of Aboriginal Community Controlled Health Services participating in the Subsidising PBS Medicine Co-payments Measure.
2010-11 Target:	80%	2010-11 Actual:		95.7%
Result: Indicator met.
Uptake of the measure by Indigenous Health Services has been higher than anticipated. This indicates a high level of awareness of this program among Indigenous health services.

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National Prescribing Service

National Return and Disposal of Unwanted Medicines Program

Figure 2.4.2.2: NatRUM Collections Between 2000-01 and 2010-11

Text version of this chart

Whole of Program Performance Information

Program 2.2: Pharmaceuticals and Pharmaceutical services

Pharmaceutical Benefits Scheme

Stakeholder Engagement

Increase Sustainability of the Pharmaceutical Benefits Scheme

Growth of the Pharmaceutical Benefits Scheme

Memorandum of Understanding with Medicines Australia

Expanded and Accelerated Price Disclosure Policy

Qualitative Deliverable:	Provide advice to affected sponsors of outcomes from price disclosure, three times a year, based on calculations from data collection.
2010-11 Reference Point:	Data collection and calculations completed in a timely manner to allow determination and notification to be made in accordance with regulations.
Result: Deliverable met.
Data collection for the first part of the first main cycle of Expanded and Accelerated Price Disclosure has been completed. 112 out of 115 separate data submissions were received by the deadline on 12 May 2011 and the remaining three have subsequently been received.
Qualitative Deliverable:	Put in place a dispute resolution framework for PBS price disclosure by 2010-11.
2010-11 Reference Point:	Dispute resolution framework implemented in a timely manner.
Result: Deliverable met.
A dispute resolution process has been developed with and agreed to by industry through the Price Disclosure Working Group in February 2011, and presented to industry at the Price Disclosure Education Workshops in Sydney and Melbourne in March 2011.
Quantitative Deliverable:	Percentage of notification to affected sponsors of outcomes from price disclosure calculations.
2010-11 Target:	100%	2010-11 Actual:	100%
Result: Deliverable met.
In 2010-11, all sponsors affected by price disclosure related price reductions were notified prior to the reduction taking place.
Qualitative KPI:	Achieve better value from medicines that are subject to price competition by applying price disclosure processes.
2010-11 Reference Point:	Accurate and timely price disclosure calculations and notification to affected sponsors.
Result: Indicator met.
In 2010-11, determinations were made for the fifth, sixth and seventh rounds of price disclosure, resulting in price reductions on 1 April 2011 and 1 August 2011. Consistent with the relevant legislative requirements for price disclosure, all affected sponsors were notified more than six months prior to the reduction dates.

Medicine Price Reductions

Streamlined Listing Processes

The objective of the Managed Entry Scheme is to develop a mechanism under which PBAC may recommend listing of a medicine at a temporary price justified by existing evidence, pending submission of more conclusive evidence of cost effectiveness which may justify a higher future price. This scheme ensures Australians’ access to medicines of high clinical need is not delayed due to price negotiations.

Quantitative Deliverable:	Percentage of submissions to the PBAC for PBS listings that are considered within 17 weeks of lodgement.
2010-11 Target:	100%	2010-11 Actual:	100%
Result: Deliverable met.
In 2010-11, all submissions lodged with the secretariat of the PBAC, on or before the advertised cut-off date, were considered by the committee at its next scheduled meeting, within 17 weeks of lodgement.
Qualitative KPI:	Develop strategies with consumer groups to encourage consumers to participate in the consideration of PBAC submissions.
2010-11 Reference Point:	Strategies developed in a timely manner.
Result: Indicator met.
Throughout 2010-11, the PBAC Secretariat engaged with consumer groups and stakeholders, such as the Consumers Health Forum, CF Australia, to enhance the input of consumers into the consideration of submissions by the PBAC. In 2010-11, there were 288 consumer submissions on matters before the PBAC, which was higher than the 187 received in 2009-10. Consumer comments on medicines under consideration by the PBAC are sumarised and provided to the medicine’s sponsor and are taken into account by the committee in its decision making process.

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PBS Cost Recovery Arrangements

New Medicine Listings

The Pharmaceutical Benefits Pricing Authority (PBPA) is an independent, non-statutory body established by the Minister for Health and Ageing. As part of its responsibilities, the PBPA reviews prices of all brands of pharmaceutical items listed on the PBS at least once each year. This year, for the first time, the PBPA Annual Report is included as an appendix to the departmental Annual Report (Appendix 3) for consistency with that of the PBAC.

In accordance with the Memorandum of Understanding with Medicines Australia, for those submissions requiring Cabinet approval, the Government has undertaken to use its best endeavours to implement a maximum time frame of six months for consideration and decision by Cabinet. The six months commences from the date of notification by the department to the sponsor that pricing is agreed. This arrangement applies to submissions considered by PBAC from its July 2010 meeting onward. For the high cost medicines³¹ listed in 2010-11, subject to the provisions of the Memorandum of Understanding, the average time from the date of the pricing agreement to Cabinet consideration was about 3.5 months.³² Two of these medicines, fingolimod and levodopa with carbidopa, were considered by Cabinet within one month of the proposed price being agreed.

Given the current fiscal environment, the Government decided in 2010-11 that all positive recommendations made by PBAC and the PBPA for new or amended PBS listings and price increases which have a financial impact for Government, will be considered by Cabinet. Previously, Cabinet consideration was only required for the listing of high cost medicines with a cost greater than $10 million. Since the introduction of these arrangements, additions and changes to the PBS and Life Savings Drug Program recommended by the PBAC have generally been listed in accordance with established timeframes under the revised approval process.

In 2010-11, the listing of the following high cost medicines was announced.

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Table 2.4.2.1: High cost medicine listings announced in 2010-11

Medicine	Indication	Listing date	Est. no. patients p.a.	Est. expenditure – 5 yrs
Azacitidine	Certain types of Leukaemia	1 February 2011	670	$124.2 million
Dutasteride	Benign prostate enlargement	1 February 2011	84,000	$77.1 million
Extension of the listing of nicotine patches	Smoking cessation	1 February 2011	72,000	$54.5 million
Extension to the listing of varenicline	Smoking cessation	1 February 2011	11,000	$48.9 million
Romiplostim	Rare blood disorder	1 April 2011	300	$73.0 million
Levodopa with carbidopa	Parkinson Disease	1 May 2011	190	$49.2 million
Cetuximab	Late stage bowel cancer	1 September 2011	2,700	$272.9 million
Fingolimod	Multiple Sclerosis	1 September 2011	2,500	$184.8 million

In 2010-11, 142 new medicines or extensions to existing PBS listed medicines were added to the PBS at a net cost of $439.9 million over five years. During the same period, given the current fiscal environment, the listing of seven medicines was deferred until fiscal circumstances permit. One of the deferred medicines, dutasteride with tamsulosin, was listed on the PBS on 1 August 2011.

Qualitative Deliverable:	Price negotiations with sponsors and conditions for listing finalised, and quality and availability checks undertaken for new PBS listings.
2010-11 Reference Point:	All negotiations and listing activity completed in a timely manner.
Result: Deliverable met.
The listing requirements for the 142 new medicines or extensions to existing PBS listed medicines listed on the PBS (after consideration by PBAC and approval by the Government, against appropriate criteria such as quality, availability and price), were completed in a timely manner, taking into account that the department must negotiate outcomes with sponsors.

Deferred listings will be reconsidered by Government when appropriate to do so, and do not need to be reconsidered by PBAC or the PBPA, unless a sponsor seeks a price change or presents further clinical evidence to support a new price.

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Nurse Practitioners and Midwives

Whole of Program Performance Information

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Program 2.3: Targeted Assistance - Pharmaceuticals

Life Saving Drugs Program

Qualitative Deliverable:	Provide funding to facilitate the treatment of eligible patients through the Life Saving Drugs Program.
2010-11 Reference Point:	Timely allocation and expenditure of funding.
Result: Deliverable met.
All applications were assessed, and all patients were reviewed every six months against the relevant eligibility criteria for the respective disease. Drug orders were placed in a timely manner and risk share arrangements were in place for the majority of suppliers to cap Commonwealth expenditure.
Quantitative Deliverable:	Number of patients assisted through the Life Saving Drugs Program.
2010-11 Target:	191		2010-11 Actual:		210
Result: Deliverable met.
The department provided assistance to 210 patients through the Life Saving Drugs Program. All eligible patients who met the criteria for access to the program were assisted in 2010-11. The higher than forecast number is a result of the demand‑driven nature of the program and patient access to a new drug listed during this period.
Qualitative KPI:	Eligible patients have timely access to the Life Saving Drugs Program.
2010-11 Reference Point:	Patient applications processed within 30 calendar days of receipt.
Result: Indicator met.
All applications were processed and fully subsidised medicines provided within 30 calendar days of receipt of complete applications.
Quantitative KPI:	Percentage of eligible patients with access to fully subsidised medicines through the Life Saving Drugs Program.
2010-11 Target:	100%	2010-11 Actual:		100%
Result: Indicator met.
The department provided fully subsidised medicines to eligible patients, however, due to global supply shortages of Fabrazyme® and Cerezyme®, the dose for some patients was reduced. This was managed in consultation with relevant clinical advisory committees and the doctors of affected patients.

Whole of Program Performance Information

Program 2.4: Targeted Assistance – Aids and Appliances

National Diabetes Services Scheme

Type 1 Diabetes Insulin Pump Program

Qualitative KPI:	Monitor the impact of changes to the type 1 Diabetes Insulin Pump Program.
2010-11 Reference Point:	Monitoring concludes that the program meets its intended aim of assisting families with children under 18 with type 1 diabetes with the cost of purchasing insulin pumps.
Result: Indicator met.
The department has analysed program participation rates and clinical information provided by the Juvenile Diabetes Research Foundation. Although the number of insulin pump subsidies provided in 2010-11 grew largely due to the changes made to the program in 2010 and the communication activities conducted in 2011, only 50% of the target was achieved. The department will continue to monitor the impact of these changes and will conduct a comprehensive review of the program in 2011-12 to ensure that it fully meets its objective of subsidising the cost of insulin pumps for eligible families who have children with type 1 diabetes.
Quantitative KPI:	Percentage of eligible applicants receiving subsidised insulin pumps.
2010-11 Target:	100%	2010-11 Actual:	100%
Result: Indicator met.
All applicants who satisfied the eligibility criteria and proceeded with their application to participate in the program received subsidised insulin pumps.

Stoma Appliance Scheme

Qualitative Deliverable:	Eligible people with stomas are provided access to new and innovative stoma products appropriate for their conditions.
2010-11 Reference Point:	New stoma products are approved and listed in a timely and effective manner.
Result: Deliverable not met.
Although no new products were listed on the scheme during 2010-11, there are more than 420 products available to assist eligible people effectively manage their condition. A new application and assessment process will ensure that new and innovative products are considered by the Government for future listing. The department reopened the application process to assess new products in June 2011. The first products to be assessed under the new arrangements will be considered for potential listing during 2011-12.
Quantitative Deliverable:	Number of people receiving stoma related products.
2010-11 Target:	38,500		2010-11 Actual:		39,023
Result: Deliverable met.
The Stoma Appliance Scheme is a demand driven program and the number of people assisted varies throughout the year. The number of people who accessed the program in 2010-11 was higher than anticipated. This is directly related to the number of ostomy surgeries performed during the year.
Qualitative KPI:	Evaluate the implementation of a sustainable listing and pricing process for the Stoma Appliance Scheme.
2010-11 Reference Point:	Evaluation concludes that approved new listings have been added to the Stoma Appliance Scheme’s Schedule in a sustainable manner.
Result: Indicator not met.
The department opened the revised application process to list new products on the Stoma Appliance Scheme in June 2011 and implemented a revised pricing structure for the scheme which came into effect on 1 July 2011. The department’s assessment panel is expected to consider applications to list new products during 2011-12. The department will continue to evaluate the implementation of the revised program framework in 2011-12.
Quantitative KPI:	Percentage of new product listings completed in accordance with the new pricing and listing process.
2010-11 Target:	100%	2010-11 Actual:		Not applicable
Result: Not applicable.
No new listings were added to the Stoma Appliance Scheme’s Schedule in 2010-11 as the revised program framework was implemented in June 2011. However, the first products to be assessed under the new arrangements are to be considered for potential listing during 2011-12.

National Epidermolysis Bullosa Dressing Scheme

Whole of Program Performance Information

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Outcome 2 – Financial Resources Summary

	(A) Budget Estimate1 2010-11 $’000	(B) Actual 2010-11 $’000	Variation (Column B minus Column A) $’000
Program 2.1: Community Pharmacy and Pharmaceutical Awareness
Administered Expenses
Ordinary Annual Services (Annual Appropriation Bill 1)	285,697	283,572	(2,125)
Departmental Expenses
Ordinary Annual Services (Annual Appropriation Bill 1)	15,197	15,149	(48)
Revenues from other sources (s31)	261	234	(27)
Unfunded depreciation expense	453	376	(77)
Operating loss / (surplus)	-	1	1
Total for Program 2.1	301,608	299,332	(2,276)
Program 2.2: Pharmaceuticals and Pharmaceutical Services
Administered Expenses
Ordinary Annual Services (Annual Appropriation Bill 1)	192,974	192,870	(104)
Special appropriations
National Health Act 1953 - Pharmaceutical Benefits	9,041,971	8,774,856	(267,115)
Departmental Expenses
Ordinary Annual Services (Annual Appropriation Bill 1)	35,120	35,008	(112)
Revenues from other sources (s31)	603	541	(62)
Unfunded depreciation expense	1,047	868	(179)
Operating loss / (surplus)	-	2	2
Total for Program 2.2	9,271,715	9,004,145	(267,570)
Program 2.3: Targeted Assistance - Pharmaceuticals
Administered Expenses
Ordinary Annual Services (Annual Appropriation Bill 1)	137,648	103,198	(34,450)
Departmental Expenses
Ordinary Annual Services (Annual Appropriation Bill 1)	1,800	1,794	(6)
Revenues from other sources (s31)	31	28	(3)
Unfunded depreciation expense	54	45	(9)
Operating loss / (surplus)	-	-	-
Total for Program 2.3	139,533	105,065	(34,468)
Program 2.4: Targeted Assistance - Aids and Appliances
Administered Expenses
Ordinary Annual Services (Annual Appropriation Bill 1)	621	610	(11)
Special appropriations
National Health Act 1953 - Aids and Appliances	246,113	244,738	(1,375)
Departmental Expenses
Ordinary Annual Services (Annual Appropriation Bill 1)	1,901	1,895	(6)
Revenues from other sources (s31)	33	29	(4)
Unfunded depreciation expense	57	47	(10)
Operating loss / (surplus)	-	-	-
Total for Program 2.4	248,725	247,319	(1,406)
Outcome 2 Totals by appropriation type
Administered Expenses
Ordinary Annual Services (Annual Appropriation Bill 1)	616,940	580,250	(36,690)
Special appropriations	9,288,084	9,019,594	(268,490)
Departmental Expenses
Ordinary Annual Services (Annual Appropriation Bill 1)	54,018	53,846	(172)
Revenues from other sources (s31)	928	832	(96)
Unfunded depreciation expense	1,611	1,336	(275)
Operating loss/(surplus)	-	3	3
Total expenses for Outcome 2	9,961,581	9,655,861	(305,720)
Average Staffing Level (Number)	280	281	1
1 Budgeted appropriations taken from the 2011-12 Health and Ageing Portfolio Budget Statements and re-aligned to the 2010-11 outcome structure.

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²⁵ Available at: www.health.gov.au/pharmacy
²⁶ Available at: www.nps.org.au/bemedicinewise/brand_choices
²⁷ Information on the number of non-subsidised prescriptions supplied, that is, those under the patient co-payment amount, is generally not available. Information from a sample of pharmacies is only available after the end of a reporting period. This is due to the nature of the survey used as a source of data, and the length of time pharmacies take to submit prescriptions. The latest prescription supply data available for 2010-11 is to end of March 2011.
²⁸Formulary Two (F2) consists of drugs where there is brand competition on the PBS.
²⁹ The target of $9m was printed in error. The correct figure for 2010-11 is $38m, as reported by PricewaterhouseCoopers, 2010 The Impacts of Pharmaceutical Benefits Scheme Reform, report for the Department of Health and Ageing, page 91, Appendix A Table 3; Savings to Government by year.
³⁰ Includes savings to both the Pharmaceutical Benefits Scheme and the Repatriation Pharmaceutical Benefits Scheme.
³¹ Changes to the PBS that result in an increase in outlays of more than $10 million in any of the first four years of listing.
³² Includes the drugs fingolimod (Gilenya®), levodopa with carbidopa (Duodopa®) and romiplostim (Nplate®).
³³ Available at: www.pbs.gov.au by browsing under ‘Midwife items’ & ‘Nurse Practitioner items’.
³⁴ Available at: www.pbs.gov.au
³⁵ Available at: www.ebdressings.com.au

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