Why is it important?:Essential medicines save lives and improve health when they are available, affordable, quality assured and properly used (WHO 2004b). Affordable access to medicines is important for many acute and chronic illnesses. For chronic illnesses such as diabetes, hypertension, heart disease and renal failure, multiple medications may be required for many years to avoid complications (WHO 2004b). It is important to ensure that Aboriginal and Torres Strait Islander peoples, who experience high rates of acute and chronic illnesses, are able to access appropriate prescription medications when they are required. In Australia, the main mechanism for ensuring reliable, timely and affordable access to a wide range of prescription medications is the Australian Government's Pharmaceutical Benefits Scheme (PBS). In 2010–11, the scheme subsidised the cost of an estimated 188 million prescriptions, at a cost of $8.9 billion.
Findings:In 2008–09, total expenditure on pharmaceuticals per Aboriginal and Torres Strait Islander person was around 44% of the amount spent per non-Indigenous person ($315 compared with $710). Benefits paid through the Pharmaceutical Benefits Scheme were estimated to be 74% of the level of expenditures for non-Indigenous Australians ($250 compared with $338). In 2001–02, per person pharmaceuticals expenditure was estimated to be 33% of the amount spent on non-Indigenous people. This suggests that the gap in spending between Indigenous and non-Indigenous Australians is closing.
Mainstream arrangements account for 71% of payments for Aboriginal and Torres Strait Islander peoples. The remainder are Section 100 and other special supply PBS drugs. The gaps between expenditures for Aboriginal and Torres Strait Islander peoples and non-Indigenous Australians are greatest in non-remote areas. In remote and very remote areas, per person pharmaceutical expenditures for Aboriginal and Torres Strait Islander peoples are higher, largely due to the impact of the special provisions for remote area Aboriginal health services. In 2008–09, pharmaceutical expenditures in these areas were $304 per person for Aboriginal and Torres Strait Islander peoples, compared to $189–252 in other areas.
In 2003, the number of full-time equivalent pharmacists per 100,000 population declined with remoteness, from 92 per 100,000 in major cities to 39 per 100,000 in very remote areas.
Implications:There is a large gap between PBS pharmaceutical expenditures for Aboriginal and Torres Strait Islander peoples and other Australians, although this gap appears to have reduced between 2001–02 and 2008–09. Estimation of this gap is complicated by the absence of high quality data sources on Indigenous pharmaceutical usage and expenditures. Improved estimates are now available using the Voluntary Indigenous Identifier (VII) available with Medicare data.
Access needs to be addressed at multiple levels. Prescription medicines are prescribed by primary care and specialist practitioners, and barriers to accessing these services in the first place may result in under use of medications. Once a prescription has been issued, access to pharmacies may be limited, particularly in rural and remote areas. Financial barriers, particularly for people on low incomes, can be important, despite safety net schemes. It is estimated that in 2001, around 19% of Australians did not fill a prescription because of cost (Blendon et al. 2003). Ongoing compliance is important for all patients with chronic illnesses.
The range of programs and special arrangements identified below allow intervention at multiple levels to improve access to PBS pharmaceuticals for Aboriginal and Torres Strait Islander peoples in both remote and non-remote areas.
Special supply arrangements administered under Section 100 of the National Health Act 1953, allow for PBS medicines to be provided to remote area Aboriginal and Torres Strait Islander primary health care services. The PBS medicines are dispensed to patients of the health care service by a suitably qualified and approved health professional, without the need for a prescription and at no cost. This program has played an important role in addressing medicines access problems in remote areas.
The PBS Co-payment Measure under the Indigenous Chronic Disease Package was introduced on 1 July 2010 to help address the financial barriers Aboriginal and Torres Strait Islander peoples may face in accessing PBS medicines in non-remote locations. These arrangements provide assistance with the cost of PBS medicines for eligible Aboriginal and Torres Strait Islander people living with, or at risk of, chronic disease. The identification of Indigenous clients is an important step in reaching the target population. Prior to implementation, it was estimated that over 70,000 people were expected to benefit from the new arrangements by the end of 2012–13. Uptake of the measure has far exceeded this estimate and as of 30 June 2012, approximately 150,000 Aboriginal and Torres Strait Islander patients had accessed the initiative, with ninety-six per cent (5,127) of pharmacies participating and 2.7 million prescriptions dispensed.
In 2005, the Expert Advisory Panel on Aboriginal and Torres Strait Islander medicines was formed to advise the Pharmaceutical Benefits Advisory Committee (PBAC) on medicines for the treatment of conditions more prevalent among Indigenous Australians. The PBAC recommends medicines for listing on the PBS. To date the panel has assisted with the listing of 20 items which support treatment of conditions common in Indigenous health settings. These medicines have been listed to address the greater burden of disease experienced by Indigenous Australians and morbidity almost exclusively seen in this population.
Under the 5th Community Pharmacy Agreement funding is provided to assist pharmacies operating in rural and remote areas through the Rural Pharmacy Maintenance Allowance. Programs specific to Indigenous health have also been funded including the Quality Use of Medicines Maximised for Aboriginal and Torres Strait Islander People program. The primary aim of this program is to improve medication compliance and quality use of medicines and consequently the health outcomes of Aboriginal and Torres Strait Islander peoples that attend participating Aboriginal Community Controlled Health Services in rural and urban areas of Australia.
It is important to develop a better understanding of how the various barriers impact on Indigenous Australians, in order to better target strategies. As data improve, better analysis of gaps in the PBS arrangements will be possible to inform programs and policies.Top of Page
Figure 183—Average pharmaceutical expenditure per person, 2008–09
Source: AIHW 2011Top of Page
Figure 184—Average health expenditure per person by the Australian Government on the Pharmaceutical Benefits Scheme, constant prices, by Indigenous status, 2001–02 to 2008–09
Source: AIHW 2011Top of Page
Figure 185—Average health expenditure per person by the Australian Government on the Pharmaceutical Benefits Scheme, Indigenous Australians, by remoteness, 2008–09
Source: AIHW (2010f)Top of Page