How safe is the patient safety net?

How safe is the patient safety net?

In the ‘Blogging on Demand’ series you get to choose the topic. If you have a great idea you want the world to know about, feel free to contact me. Perth GP Dr Jacquie Garton-Smith proposes a change to the PBS safety net to protect vulnerable patients.

“One thing that my patients with chronic disease on lower incomes find difficult,” says Dr Garton-Smith, “is that they have to pay for all their medications until they hit the safety net. Even if people are only paying the lower rate for scripts, it adds up if they are on a number of medications. I have seen it affect compliance at the beginning of the year when they have to decide which medications they need most.”

The general patient safety net threshold is currently $1,453.90, and the concessional threshold $366. When someone or their family’s total co-payments reach this amount, they only have to pay the concessional co-payment amount of $6.10 until the end of the calendar year. Concessional card holders get standard PBS scripts for free after they reach the threshold.

The PBS co-payment and safety net amounts, effective from 1 January 2015:
General patient co-payment: $37.70
Concessional co-payment: $6.10
General safety net threshold: $1,453.90
Concessional safety net threshold: $366.00.

A safer solution

Garton-Smith: “It is crazy to load the costs into a few months of the year and then being free the rest of the year for concessional card holders. My patients tell me the safety net is supposed to help them but doesn’t – until it kicks in. For someone who has diabetes, hypertension, hypercholesterolaemia, arthritis, reflux, depression and sometimes osteoporosis, asthma or COPD, you can see the impact. This is not an unusual scenario.”

“It would be so much easier if the cost could be spread out over the year for people likely to hit the safety net. It would also prevent people attempting to stock-pile at the end of the year. I realise most people don’t get more than 5 scripts a month but those who need to are often managing serious health problems.”

Medication adherence 

Research has shown that when co-payments for medications increase, more people stop their treatment. This includes essential preventive medications, and as a result more visits to the doctor and hospital may be required.

Associate professor Michael Ortiz said in Australian Prescriber: “Some have argued that greater cost sharing does not undermine overall patient health because patients facing rising costs will reduce their consumption of perceived non-essential medications more than their consumption of essential drugs. However, ‘preventive’ drugs are different, because not all patients understand the long-term benefits of taking medicines for conditions such as hypertension and hypercholesterolaemia.”

“Some of my patients need to delay filling scripts they see as less essential

Garton-Smith: “A patient I have seen needs to buy more than ten medications every month at a cost of $85. Sometimes there are extra costs, for example if he needs antibiotics. On a single disability pension he gets $840.20 per fortnight, so approximately 5% of his income is spent on scripts until he reaches the safety net threshold, generally by May. Even though he gets a lot of prescriptions filled just before the end of December, he usually needs to delay filling scripts that he sees as less essential at the start of the year.”

Professor Michael Ortiz in Australian Prescriber: “The current approach to PBS savings is that the Government takes most of the cost savings, but increases co-payments and safety net thresholds each year in line with inflation. Increasing co-payments reduces medication adherence and ultimately may compromise the care of some patients.”

Thanks to Dr Jacquie Garton-Smith for the topic suggestion.

Follow me on Twitter: @EdwinKruys. Disclaimer and disclosure notice.

11 thoughts on “How safe is the patient safety net?

  1. Thanks so much for covering this Edwin. I think this inequity could easily be addressed by spreading out the costs over the full year for people who are likely to reach the safety net, both for concession card holders and those who don’t qualify for concessions, many of whom are also not on high incomes (meaning the latter on five or more scripts per month would pay just under $200 every month for the first five + concession rate for any after that rather than more at the start then all at concession rate). Checks could be put in place to ensure this was not rorted by buying more one month and none the next. It would lead to a much fairer system.

    Liked by 1 person

  2. Doctor Kruys, Thank you for seeing me late Friday afternoon with a bad back.​ It got a lot worse before it started getting a little better. I had to ring Caboolture Parish Priest and cancel my weekend supply for Masses as I could hardly walk. Tyrone Deere

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    • Dear Tyrone, you are more than welcome and thanks for your message. I hope you will continue to get better. Please contact the practice or book an appointment if you have any concerns about your recovery.

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  3. Why are some GPs and medical organizations resistant to Hovernment-funded GP-pharmacist collaborative medication reviews (HMRs), which part of the solution to 230,000 medication-related hospital admissions per annum?

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    • I always appreciate a well-written HMR report by a pharmacist, Debbie. In my experience most patients appreciate the service too, especially if it leads to less unnecessary medications, less side effects or interactions, and lower costs.

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        • I always try to refer to the patient’s usual pharmacy, unless my patients request otherwise. What I don’t like about HMRs? When I receive a report that is just a templated print out of MIMS or other resource, without the input of a pharmacist’s brain.

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          • Or when it is done on my nursinghome patients, without my consent and then comes back with all kinds of suggestions re taking BP, weighing, doing multiple BGLs, should be sent to a Geriatrician, etc. Oh, and a standard spiel from MIMS. Said nursinghome will not do that again as they are aware that they will then be looking for a new GP for the patients

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            • As someone who trains pharmacists to do medication reviews, I can’t count how many times I say NOT to cut and past text. Comments and recommendations MUST be individual patient centred. Nursing home reviews (RMMRs) cannot be conducted without your referral ie consent.

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            • These were done without my consent. What got my gall was the numerous clinical recommendations such as advising the staff to do daily BGLs on a diet controlled stable 94y old demented diabetic or advice to do standing and sitting BP checks on all my patients on BP meds.
              I advised the RACF that if I caught them doing BGLs like that on my patients without my instructions I would consider it assault and report the matter.

              These went way beyond the role of the Pharmacist IMHO and the actual advice on medicine issues were just cut and past with no regards to issues relevant to the actual patient’s past history. All done by a “Consultant Pharmacist” who sold his services to various RACFs in town and even sat as an advisor on a board run by our ML. Granted this was about three years ago and I have not heard his name being mentioned for at least two years so I guess you burnt his bridges in more than one location.

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