Better health and ageing for all Australians

Pharmacy

PBS Chemotherapy Medicines Review

Review of Chemotherapy funding arrangements

In this section:

Introduction

The Minister for Health, the Hon Tanya Plibersek MP has announced that the Government will provide increased interim funding for chemotherapy. The Government has also directed the Department of Health and Ageing to undertake a comprehensive review of chemotherapy funding arrangements, with a view to putting in place a longer term solution to recent issues that have been raised.

Between 1 July and 31 December 2013, the Government will provide an additional $60 per chemotherapy infusion prepared under Pharmaceutical Benefits Scheme arrangements to ensure the ongoing viability of chemotherapy services.

The review of chemotherapy arrangements will report to Government by October 2013 with recommendations for long-term arrangements for the funding of chemotherapy services.

Aim of the Review

The aim of the Review is to identify options for a long term and sustainable funding model that identifies and appropriately manages all components of chemotherapy dispensing and supply and is not dependent on the cross-subsidisation from the price of chemotherapy medicines for the viability of chemotherapy services.

The Review will not be limited to the chemotherapy dispensing services funded from the PBS. It will also consider the funding and clinical services delivered as part of a cancer patient’s treatment, and the different business models in the private and public health sectors that provide chemotherapy services and how these services have changed since the chemotherapy funding arrangements were implemented in December 2011.

Background to the review

When stakeholders first raised concerns about the price reduction of chemotherapy drugs and the potential impact on the viability of chemotherapy services in late 2012, the Minister requested that the Department investigate the issues being raised. Staff from the Department visited and held discussions with key organisations and providers to gain a first-hand understanding of the possible impact of the then upcoming price reduction on the provision of chemotherapy medicines. These organisations included chemotherapy suppliers, third party chemotherapy compounders, and private hospitals with chemotherapy services.

The Department is seeking further information to understand the complex arrangements currently in place, and the possible future arrangements that might be put in place, to ensure the sustainability of chemotherapy services in future.

Note: The Review is not expected to consider any matters relating to Medicare Benefits Schedule (MBS) items or arrangements for oncology services.

Terms of Reference for the Chemotherapy Medicines Review

    1. The Review will investigate and report on:
      1. Current arrangements for funding of chemotherapy services;
      2. How those arrangements have changed over time;
      3. How chemotherapy services are provided, including in relation to:
          1. Different hospital and community settings
          2. Different business models
          3. Use of third party compounders
          4. Integration of hospital, pharmacy and oncology services;
      4. The involvement of public and private hospitals in providing chemotherapy services, including
        1. the extent to which each sector provides services
        2. differences by state
        3. how that service mix has changed over time
        4. current trends in that service mix
        5. any implications for community pharmacy or the Pharmaceutical Benefits Scheme
        6. any implications for private hospitals and private health insurers;
      5. Cost structures associated with provision of chemotherapy services – dispensing, support, administration and clinical services;
    2. The Review will provide advice on funding arrangements appropriate to the efficient supply of chemotherapy services by community pharmacy.
    3. The Review will provide advice on any other relevant matters in relation to securing efficient and effective provision of chemotherapy services.
    4. The Review will ensure appropriate consultation with relevant stakeholders.
    5. The Review will report to the Minister for Health by October 2013.

Review process

The review will be undertaken in three phases:
        1. Dissemination of a discussion paper for public responses;
        2. A consultation phase involving submissions from the public and bilateral meetings with a range of stakeholders. This phase is expected to be completed by the end of July; and
        3. Analysis of the public submissions and other information provided and preparation of a report to be provided to Government by October 2013. This report will provide options for amending the funding arrangements for chemotherapy to ensure long-term viability of services and sustainability of the costs involved.
To support the review, it is expected the Department will be seeking the assistance of suitably qualified, specialist consultants. It is expected that the consultants will have significant experience in health administration, cancer services and/or drug evaluation. Further information will be placed on the web site once available.

Stakeholders may contact the submissions officer on (02) 6289 1374 or via email to the Department to request a meeting.

All interested organisations will be invited to make a submission to this Review in due course.

Review timeframe

The Review will report to the Minister for Health by October 2013.

Contact for further information about the Review

Contact the submissions officer on (02) 6289 1374 or via email.