Demystifying 60-day prescribing: a closer look

0:00 okay folks we'll might get the ball rolling because we're at 3 o' and always conscious of your time note that we're recording today's session so if anyone arrives late they can always look at the whole webinar in their own time so let's make a start always lovely to know where you're coming from what country you're on I'm on orer country I mean n the

0:31 the land of the cooler Nations and I'd like to begin by acknowledging and paying respect to theal owners of this land I'd like to pay respect to Elders both past and present and also acknowledge their relationship the continuing relationship to land here and always was and always was will be love to hear where you're coming from if you want to pop in the chat where you are today and the the topic today is the

1:02 60-day prescribing the change in prescribing for some medications and the plan is that we've been asking folks to send us in their questions about this policy we've got quite a few what I'd love you to do is if you have a question and you haven't asked it yet you can put it into the Q&A box now if it's very similar to one of the Dozen questions I've got in front of me I'll I'll probably roll it up there but maybe

1:31 you've got a different question in which case if you put them in now we'll have a chance to add them in to the questions for today so I really encourage you if there's a question you want to ask put into the Q&A your question so that we can address it a few other housekeeping things as I said this webinar is really about any questions you've got about this new 60-day prescribing policy we'll be working our way through those

1:59 questions questions as best we can and put your questions into the chat so that we're able to answer those for you as we go I'd also like to introduce I think his name was on the last slide there David Laughin from the Department of Health and Age Care we're extremely fortunate to have David with us today he's a very experienced senior public servant whose role as assistant secretary in the pharmacy

2:31 branch is to be responsible for this policy also he has a range of other things in this general area so responsible for Community Pharmacy some of you might familiar with section 100 particular aspect of some medicines sit under section 100 he's responsible for the a lot of Highly specialized drugs for diabetes and a range of other areas that sit and the broader Banner of Pharmacy so terrific to have someone with such great experience of Pharmacy and in are with us today to be able

3:02 to answer these questions so thanks very much for being able to join us David so in a moment David will be giving us a little bit of an update on the policy and a little bit of a statement and once he's done that then we'll go to number four which is the questions that we got before the webinar so we'll hear from David then we'll go through your questions and then if there are any more questions that

3:29 you're adding in now if there's time we'll do those at the end so send your questions in if you've got them so we've got time to look at them and if we can address them so now I'd like to hand over to David who's going to give you an overview of where we are to far and once again David thanks so much for your time today yeah thank you very much Elizabeth it's a pleasure to be joining you

3:51 great to be here today and I'm pleased to be able to take this opportunity to speak directly to Consumers so the introduction of 60-day prescriptions is an important initiative that will help consumers to save time and money with their medications for those with chronic conditions this policy will have a significant ongoing and positive benefit in the management of medications for their conditions the implementation of 60-day prescriptions is occurring in three stages across 12

4:22 months stage one commenced on the 1st of September 2023 and includes 90 medicines and presents roughly onethird of all the medicines eligible for 60-day prescriptions and this includes medicines for cardiovascular disease Crohn's disease gout heart failure high cholesterol hypertension and osteoporosis to name just a few the order of medicines to be made available in stages two and three in March 2024

4:52 and on the first of September 2024 respectively are still being finalized the independent expert pharmaceutical benefits advisory committee has provided advice and recommendations on the clinical safety and suitability of the list of PBS items for 60-day prescriptions only patients with certain chronic medical conditions who are stable on their current treatment regime are eligible for the increased quantities to qualify for 60-day prescriptions patients must live with an

5:24 ongoing health condition be assessed by their prescriber as being stable on their current medication have discussed their medication with their prescriber and have received a new prescription for that 60-day medicine the decision to write a prescription for the increased Supply is that of the prescriber usually a GP but sometimes a nurse practitioner who will make the decision based on the patient's clinical appropriateness and need eligible consumers buying PBS

5:54 medicines will save more than $1.6 billion collectively over the next four years from 60-day prescriptions and patients with a 60-day prescription May save up to $180 a year per medicine for Medicare card holders who do not have a concession card and $43.80 a year per medicine for concession card holders for an eligible patient who pays the $30 General co- payment for their PBS medicine they will receive 60 days worth

6:25 of medication for the cost of 30 days the savings however will be less where the cost of the medication is below the maximum $30 PBS General co-payment amount or additional manufacturer SE charges such as brand price premiums are applicable pharmacies can offer discounts for medicines that cost less than the $30 PBS co- payment and the size of the discount is at the discretion of each Pharmacy and can vary over time in all

6:55 instances patients will pay no more than the maximum General patient charge for their medicine as shown on the PBS schedule so in relation to Brand premiums in some cases patients May pay a special patient contribution called a brand a brand premium or therapeutic group premium if it applies to certain brand or brands of a medicine these payments will still be required with 60-day prescriptions the brand price premiums apply to each pack of medicine therefore if two packs of

7:27 medicine are provided under a 60 day prescription to Brand premiums will apply to avoid the brand price premium the patient has the option to accept a generic brand unless the prescriber has ticked the no substitution permitted box on the prescription in relation to the safety net there are no changes to the PBS safety net scheme because of the 60-day dispensing initiative the PBS safety net scheme continues to protect patients and their families from incurring excessive

7:58 costs in relation to the supply of medicines the safety net is there for those families and individuals who have a high PBS outof pocket cost it is there to provide additional support for these patients some Australians will save enough money that they don't even need the protection of the safety net threshold anymore others will save enough money that they hit that safety net threshold later in the year those patients that hit the safe the threshold later in the year won't pay any more but

8:28 their total annual pocket so their total annual outof pocket medicine's cost Remains the Same but their Med monthly medicine's cost is likely to reduce in 2023 that's a total of $262 180 for a concessional patient or $1,563 for a general patient so increased dispensing quantities is a landmark structural reform that addresses the affordability of medicines for all Australians IT addresses the cost of living pressures that many are

8:59 currently facing and reduces pressure on our doctors and The Wider Health System I encourage you to access the cheaper medicine's website and to talk to your doctor at your next appointment to see whether a 60-day prescription is right for you thank you very much Elizabeth well that was fantastic David and I feel like I'll need to binge that on the weekend because there was so much content in what you said there are a couple of questions that come from

9:28 what you said before I go is does the GP say or can I sorry Elizabeth I've lost you are you still

9:58 there sorry Elizabeth I said be having some connection issues for listening to you are you still there I am still here but you're Frozen okay I can hear you great sorry I'm sure it's the Wi-Fi where I am my apologies yes Henry I I suspect its technology doing its best for us so just try and bear with us

10:30 can you still am I still frozen for you David So Elizabeth I can hear you clearly but I didn't get any of your question if you'd care to repeat that please yeah sure I was just saying you mentioned brand price premiums and the question is I feel like I'm now princess Elsa because everyone says I'm frozen sorry but the question is how would I know if I was getting a drug and it was one of these brand price premium

11:00 things like do I would I already know that as a consumer or is that something I need to check with my pharmacist it's something you can check with both your doctor and the pharmacist and generally if you go into a Community Pharmacy and you have something that attracts a brand price premium so for a brand price premium to be able to charge to be charged there must be a generic substitute available for it so if you do go into the

11:25 pharmacy the the pharmacist would normally let you know if there's a brand price premium that's attached to a particular product and to offer you an alternative generic medicine so you should be able to to choose at that point if you haven't already been informed by your GP that's great so if I've gone in there and the pharmacist says there's a cheaper generic and I choose to have the brand price premium then I know what I'm doing I'm picking the dr1 because I want

11:52 the dr1 yeah absolutely there should be transparency in those charges at all times great well let's run through these questions now and hope the Wi-Fi behaves itself so the first question is from vidana thanks vidana she asked and I I think you covered this a little bit in your chat which is why are some drugs not on the list when others are particularly when to us it might look like they're the same kind of drug so

12:22 can you just run through again for us how that decision was made to include some drugs on this list and others got left yeah sure absolutely Elizabeth so as I said earlier the the pharmaceutical benefits advisory committee had a close look at what medicines were appropriate to be dispensed for 60 days so they're the expert independent body that provides

12:53 advice to the department and to government on Rel in relation to the safety and efficacy of medicines that's made up of doctors there's health professionals including an ex- pharmacist and there's other consumer Representatives on the the pbac as well so in making its recommendations the pbac applied you know some of the following guidance criteria to identify medicines that should not be listed with higher quantities so medicines where being able

13:24 to stockpile large quantities could pose a risk to patient safety so narcotics paracetamol Codine psychos stimulants that sort of thing so they they won't appear on the 60-day dispensing list medicines were a requirement for regular regular monitoring and frequent dose titration so changes in dose obviously means that patients aren't stable medicines where the drug regime is associated with management of a progressively worsening disease or the symptoms are associated with relapse of

13:56 disease and the patient is not expected to be stable for the next 12 months medicines prescribed for the short-term management of symptoms in chronic diseases medicines in the palive care section of the schedule and medicines where the pack has recommended a listing that enables prescribers to prescribe less than six months therapy per prescription and the final criteria there was that medicines must have been listed on the PBS for 5 years or more or

14:27 generics of medicines that have been Ed for 5 years or more as severe but rare adverse effects frequently become evident during the first couple of years a drug is widely available so that was part of the safety considerations for the paback so they did give particular attention to drugs that were used to treat mental illness very high-risk drugs such as those used to treat major psychoses the benzo dipine anti-anxiety hypnotic drugs will not be

14:57 available for that 2 months Supply but other anti-depressants where appropriate will be available for two month supply so for example modern anti-depressants have which are largely used now have a much better safety profile than than anti-depressants and so that's why you would see for example a difference in in that category and why the pack have recommended some for 60 days and not for others fantastic that was really helpful David now the next question is from

15:29 mariann's asked a question and actually Morin's asked a similar question so I'll put kind of bring them together it's really about the impact of this policy on pharmacies particularly on smaller Independent Pharmacies or pharmacies that are in remote or rural environments so what people are hearing from some pharmacists is that this is a big financial problem for them and people are concerned about the impact on their Pharmacy they really came to understand from the Department's perspective how are you helping

15:59 pharmacies and is it true that they're all going to be financially significantly disadvantaged to this can you run us through how the government's making sure that our community pharmacies can stay open yeah thanks very much Elizabeth it is very important to the government that community that Community Pharmacy continues to stay open and service the communities in which they're operating and Minister Butler has continued to say publicly that he wants a thriving Pharmacy sector he's looking for pharmacists to come out from behind

16:31 the counter and rather just dispense medicines to actually engage in further Professional Services which expand a pharmacist scope of practice so firstly I would say that the savings to government as a result of this measure every single scent is being reinvested back into Community Pharmacy through a variety of of different programs and those programs are in the area of those Professional Services to allow a pharmacist to work you

17:02 know more broadly to a to a more full scope of practice and engage with their consumers in a different way rather than just dispensing drugs and the second thing is the government was particularly mindful of the impact of this on smaller Regional Rural and remote pharmacies and that's particularly because while in major cities there's a lot of foot traffic with people coming through those pharmacies both in terms of the dispensing of medicines but also the

17:34 products that are available from a retail perspective throughout the rest of a pharmacy and recognizing that Regional rural and remote pharmacies simply have less foot traffic available to them so the first thing that the government did was double the Regional Pharmacy maintenance allowance and so in some cases for at the most if you like significant end of the scale for a pharmacy in a remote area who does less than

18:05 22,000 scripts perom that they'll receive somewhere in the order of just short of $400,000 over the course of the next four years from the Regional Pharmacy maintenance allowance and that essentially on average ensures that the pharmacies in those areas particularly all pharmacies in the sort of mm 4 to7 essentially receive compensation if you like or but a

18:36 kind of a neutral position on average from the Lost Revenue as a result of 60-day dispensing and the additional investment through this Regional Pharmacy maintenance allowance the second thing that the government's done for pharmacies in rural Regional and remote areas is a a regional M Regional Pharmacy transition allowance so this is something that will go up for the next four years so the Regional Pharmacy maintenance allowance is an ongoing program the Regional Pharmacy

19:07 transition allowance is something that will be provided over the course of the next four years and that provides additional support to essentially any pharmacy with a script volume less than about 60,000 scripts per year and that is you know in recognition of the lower amount of foot traffic in some of those areas and c and customers coming through a pharmacy and so just to give you one

19:38 example so pharmacies that have in mm3 four five six or seven so you know that's up to towns of about population of around about 50,000 if you had a Farm if you had a script volume of between 45,000 and 57,000 the then over the course of the next four years you would receive in total from both of those programs somewhere between 420 and 490,000 so

20:09 that's a really significant reinvestment in the ongoing viability of pharmacies in our regional Rural and remote areas and some very strong support through those two government programs in particular as well as the ability for those pharmacies to access the programs with additional Professional Services whether that's providing the ongoing programs that are currently under the 7th CPA so your dose Administration AIDS and medications

20:39 checks and home medications reviews it also goes to the availability of opioid dependence treatment about providing National immunization programs vaccines which will come online from the 1 of January next year so there is considerable support being provided by government to Alles in that regard yeah there's a lot of things going on there David so you've said that the government's made an undertaking that any money it saved would go back to Pharmacy some of that will be giving

21:09 them new jobs to do that they're not able to do now like those immunizations for examp apologies Elizabeth I seem to have lost you

21:51 again I'm still here Elizabeth but I can't hear you yeah okay I'm back again I can hear you yeah hopefully you can see me sorry folks this is not great but I can't kind of move now because I finished I just said David it sounds like the money that the government is is saving it's reinvesting into Pharmacy both through giving pharmacists money to do other things like immunizations and then it's been aware that particularly small pharmacies and

22:23 they're often in more remote or rural areas giving them this extra money to help keep them viable and you said up to half a million dollars in some cases for pharmacies I think one of the questions that in the chat was what about the really small Pharmacy so hey Moren up in Tambo saying there's 180 people in our town so we're really remote and the foot traffic for our Pharmacy will be even less again so maybe you can't answer

22:50 that but just to note I think people are wondering when they really small Pharmacy environments is there anything extra special that happens or or is it a one siiz fits-all so it isn't a one-size fits-all because there are script volume bands but if you were a really small so the payments are made about the average of the scripts within those script volume bands and so to give you an example in the script volume band of

23:20 0 to 23,000 scripts the averages sits around about 20,000 so if you had considerably less than that because you're a very small Pharmacy actually because the the amounts of money tipped in through those programs such as the Regional Pharmacy maintenance allowance is on average to to equal out so there's there's no Revenue reduction per Pharmacy those pharmacies will actually end up in front like that's the good news for the the really good phes is

23:52 that not the Regional Pharmacy maintenance allowance might might not just cover the revenue reduction from 60-day dispensing it might well exceed that Revenue reduction from 60-day dispensing fantastic so then the next question is about how to have a conversation with the pharmacist so people are some have people have given us some examples of experiences they've had when they go to the pharmacy and the pharmacy tells them that they're not eligible sometimes they

24:23 say they're not eligible because your medicine is a agent generic and it doesn't apply to generics some are being told that they don't have a healthcare card they can't get it and some are hearing from pharmacists when they take their scripts in they're getting a bit of a a monologue about why this is a really bad idea so can you give us some advisor how can the department how can government help people have these maybe awkward or difficult conversations

24:50 when they believe they're entitled to the 60-day script but it seems their Pharmacy is telling them that they can't have it sure there's a couple of things there Elizabeth so forgive me if I I don't get any all of them I'm happy for you to remind me but basically the bottom line is if you're a Medicare card holder and a prescriber makes a decision that you are suitable for a 60-day script and writes that 60-day script you

25:15 are eligible doesn't matter if you only have a if you don't have a concession card that's not relevant that just goes to the actual price that you will pay for the medicine if you have a Medicare card regardless of whether you're concessional or not the only difference there is $730 as a concession card holder or $30 as a general patient but you are eligible for a 60-day script so I think that there's there is you know some difficulty there

25:47 in terms of some difficult conversations potentially to to happen if you know there's some kind of concerns around around what a pharmacy will or won't Supply so I do think that there are a number of scenarios that can result in in potentially you know Pharmacy not supplying or not wanting to supply and some of that might be you know quite simply some education for pharmacists we've been

26:18 running a number of webinars to connect with pharmacists to ensure that they understand not just the policy but how it's actually operationalized and so we've answered many many questions over the course of the last few months and engaged with many pharmacists as part of webinar series but for I do understand that for people if you turn up at at the at the desk and you hand over your prescription and the pharmacist for some reason tells you not

26:45 eligible then what do you do because that is a you know is a difficult situation what I can what I can do is for people make available and we might put some EXT extra information on the department's website as a result of this because I I understand that you know we want to make this as clear as possible that that everyone who has written a script 60-day script from a GP or a nurse practitioner is eligible for

27:12 that 60-day script You can call the department we have a helpline which is 1 80020 103 so that's our general inquiries line so again for the Department 1 180020 103 or you can email inquiries health.gov that's inquiries inquiries with an E not an i inquiries health.gov doou and those those inquiries will make

27:44 their way through to my team and we'll be able to deal with people's individual circumstances in in the story that they tell us as to what some of the barriers might have been or what some of the issues might have been in relation to accessing that 60-day script we're more than happy to help that's really great that's very helpful thanks David the next question is about the closing the gap program so how does this relate to

28:16 people who have accessed the indigenous Health incentives or the closing the Gap scripts programs does it make a difference for them no it doesn't actually so the the PBS the closing the Gap PBS co-pay program which sees PE which for indigenous people who have who have registered if they were generally a concessional sorry if they were a general patient they get their script

28:47 for the the price of a concessional patient they're concessional patient they get the the script for free those arrangements haven't changed they apply equally to all Scripts doesn't matter whether that script is a 30-day script or a 60-day script a eligible indigenous person can access that for under the normal PBS copay Arrangements sorry the the closing the Gap PBS copay Arrangements great and another PBS question which is are only

29:17 PBS medicines included in this what about things like imog globulin products it is definitely only the the people s medicines that are on there so they have to be I know this this probably doesn't mean a lot to Consumers but on that section 85 which is the General Schedule medicine so things that are listed on the p PBS for which the Commonwealth government will pay a subsidy for so they need need to be there for for

29:49 that to apply so in relation to imunoglobulin products that isn't something that's on the the PBS and but the full if you like the full list of medicines that is available is up on the department's website and people can go and have a look at that and explore that list in full great David thank you so then we talked a little bit about pharmacists people are interested to know what feedback you're getting about how GPS

30:21 are engaging with this do you have a sense of how many 60-day scripts have been written and how happy GPS are to write these scripts and also you could add if you want to if you're getting any feedback about how how pharmacists are going you said you've engaged them a lot how are they feeling sure so I think that it's first of all it's a little bit too early to tell in terms of the data that's

30:46 that's starting to come through in relation to to 60-day dispensing and the volume of scrips that might be part of that so we we will continue to to monitor what's going on on in that space but of course we generally expect a reasonably slow uptake if you like of 60-day dispensing and that's because people who have a script written by their doctor for their chronic condition they might have a significant number of repeats that are

31:16 left on that script then it doesn't make sense to go back to your doctor and get a 60-day script because the you know the the from the e ICS of it it it may not just be worthwhile so essentially we would and also the difficulty you know sometimes in some parts of Australia of of being able to get to a an appointment with your GP which can take some time so we'd certainly expect that on the next

31:46 scheduled U monitoring visit with the GP that the both the GP and the patients will be able to have a conversation about whether 60-day dispensing is appropriate for them and so it might take some time for if you like the uptake of 60-day dispensing to really be seen in the data that we'll have available to us so there was a second part to your question Elizabeth asking what you're hearing from pharmacists we kind of said

32:17 that consumers are hearing that some pharmacists are not happy consumers are wondering what the department in its engagements heard cons perhaps they're happier when they talk to you David well think the department continues to engage both with GPS and with pharmacists in relation to education on this policy and to the Practical implementation of this policy some of the very early feedback that we've heard suggests that there is my some misunderstandings out there both you

32:48 know on behalf of of the GPS and some pharmacists and we're just working with with all of them we're working with the peak bodies from both of those professions to help continue that education and ensure that the the policy is implemented as it's intended to be great thanks Jenny asked a question about accessing 60-day scripts and I think you've answered that if if you're on the call today and you think that some of your medicines could be eligible

33:17 under the 60-day scripts you've looked at the Department's website looks like it's there your script can only be changed by the person who wrote it so you need to go and make an appointment to see whatever it was your GP for example it could be specialist and say look here's my script I'd like it to be every two months and if they have a conversation and that's a good idea then they'll give you the script and then you

33:39 take that to the pharmacy and then you're eligible and I know man and a few others have asked about but I got charged extra because I didn't have a health I've Lost You Again

34:20 Elizabeth Elizabeth you there how we going am I back on you're back I

34:53 can hear you great I'm going to just leave my video off I don't know if it'll make any difference but I'm having a lot of fun as Princess Elsa today I have to say so thanks for that answer there's a couple of questions people asking about other drugs coming on so I think the question is how are you going to evaluate the success of this and then how might other drugs also come on over time what's the

35:21 plan so so firstly in terms of the evaluation of of the success I don't have the document in front of me but there's an impact analysis that's been done by the department so when we put forward any significant or major policy we're required to do an impact analysis by the office of impact analysis and as part of that document it articulates the evaluation framework for this particular measure so what is it that we'll be looking for

35:52 when we'll be looking for and what we're going to do with that information so that impact analysis is on the the website of the Department of the Prime Minister and cabinet and so that is you know a public document and and people can have a look at that sorry what was the second part Elizabeth well on the basis that the evaluation shows that it's successful would that group of 300 drugs become a longer list people are wondering if

36:21 their medicine might one day be on the list sure so well I think that they will be determinations for the pharmaceutical benefits advisory committee both in relation to some existing medicine so you heard before that one of the criteria was which went to part of the safety profile was medicines that had been available on the PBS for more than five years or generics of those medicines that had been on the PBS for five years so there's absolutely no

36:52 doubt you know a number of medicines which might fit a and be appropriate for the management of chronic conditions under 60-day dispensing which aren't on the list yet because they haven't met all of the criteria that the pack have actually set down and then no doubt that the you know like they do with many many other things the the pack will you know monitor the information that's coming through to them both qualitative and quantitative and continue to make

37:22 decisions on the appropriateness of medicines on that list for 60-day dispensing great that's that's terrific thanks David so I've got someone saying if they go to their GP and I'm looking at the questions in the Q&A now they go to their GP they get a 60-day script from their GP that's where you need to get it folks not from your Pharmacy how long does it you have to wait until you can go back and get your

37:49 next repeat is it every six I might have lost you again but I think I've got enough of the question to provide an answer so generally you would get if you had a 30-day script you would get to at least after 20 days before being able to fill that repeat and that's for it to count to the towards the PBS safety net at the moment

38:19 for 60-day scripts that's the same the 20 days there is there has been a decision ision to change that from 20 days to 50 days for a 60-day script however there's there is you know a lot of interaction with some of our stakeholders systems to be able to do that so it couldn't be done at exactly the same time as to coincide with the 1 of September introduction of 60-day dispensing so but that will you know in the coming

38:51 months move from 20 days to 50 days so it would be 50 days for for resupply to be able to have that count towards the safety net for those 60-day prescriptions and of course with a 60-day prescription generally in most cases are written for the prescription itself plus five repeats so that is you know essentially a two Monon Supply and six lots of Supply so they should essentially that script last patients

39:23 for a year great thanks David so there's a Susan is asking about what's been doing to educate GPS about this so people saying that they went to the GP and the GP didn't know if they were eligible can you talk about what the Department's doing to make sure that the professional groups understand this so they are able to support the policy change yeah absolutely and I think this is you know part of the challenge about

39:54 ensuring that everyone is aware of everything that they need to know as part of you know such a significant policy change as I mentioned earlier we have had you know a number of webinars for prescribers We've engaged in in a number of those over the course of the last couple of months in the leadup to the 1 of September we have engaged with groups such as Peak bodies like racgp in terms of ensuring that

40:24 that their members are Ware and using those Pig bodies as a as a channel to ensure that information is shared to them and of course those inquiry lines which we mentioned before are open and we've been responding to to some doctors individually but of course whether it's a doctor or a pharmacist if we start to get a theme in relation to questions that come through then we update our frequently asked questions on the department's website that so

40:55 that everyone is able to access that information fairly quickly and easily I would say that most of the inquiries that we have had to date have essentially already been answered in the frequently asked questions that are up on the website so I encourage everyone whether that whether you're a prescriber whether you're a pharmacist whether you're a consumer to have a read of the information that's available first before getting in contact but of course if that information isn't

41:23 available then we're more than happy to respond to your queries great shirani and a few others have asked a question about the cost of their medications when it's not the $30 and it's not $720 so that group in between where the pharmacists can set the price so what people are saying there are a few questions here in the chat people saying that they're asking can pharmacists just choose the price of medicines in that group they're also

41:51 saying that they're being told that if your medicine's in that group it doesn't count for 60-day prescribing and some people are saying they've been charged twice that amount and said that you have to pay for both I can give you two months first so can you talk to us a little bit about those medicines that are in that group the group that are less than $30 and when you don't get the you know this concession card cost how

42:15 are these in scope for 60-day prescribing is are the people meant to be charged twice or they meant to be charged just for the one yeah thanks Elizabeth so there are a group of medicines as you point out that we refer to as under copay medicin so they're under that $30 and actually there are a lot of variables in this this space so I have to kind of speak fairly generically but it depends on the price of those you know initially in

42:46 terms of that you know the cost of the actual drug and we have what's called a price to Pharmacy which includes all of the markups through the supply chain that goes to setting the final price for those particular medicines so what I what I can say is that if you are a general patient and you would normally pay $30 or up to $30 for a medicine you shouldn't be paying more than $30 for those two medicines and and and that's

43:18 the exception of course being the brand price premiums that we were referring to earlier so those medicines that are under copay doesn't they are absolutely eligible for 60-day dispensing if they are on the 60-day dispensing list of medicines so all of the the the GPS their their software is updated if you're getting a script from a GP the GP will be able to see on the screen that they have an option for either 30 days or 60 days and that will help prompt

43:48 them to have that conversation but it's about the medicine and the safety profile of that medicine if it's on the 60 dispensing list and go into the to the pharmacy and get a 60-day supply and that will J all you know that will generally be cheaper so for those under coopay medicines it's not necessarily the 60-day supply for the price of a 30-day Supply there is a bit of a difference in that it's sort of an in between space

44:18 but certainly shouldn't exceed the general patient co-pay of $30 in total for the 60 days that are dispensed to great thanks David there's a question being asked about by Robin so if now the we're getting two boxes of medicine and we're only paying for one box of medicine then how's that other cost being met the the government's just take just

44:48 accepting that loss and paying for the extra packet or have the medicine medicine manufacturers reduced the cost what how are you managing that loss if you like what's happening there yeah so it's actually a a pretty complicated equation in terms of the way the money flows and some of it's about dispensing fees and and markups and some of it means that the consumers are the the biggest recipients if you like of the savings as part of

45:19 all of this measure the Commonwealth in theory from 60 dispensing has a saving as well but as we noted earlier all that money is being reinvested into Community Pharmacy but essentially there's the consumer pays half the generally half the co-pay that they you know otherwise would have and the because the pharmacist is providing two boxes if you like rather than one box but

45:50 they're getting the same dispensing fee for providing those two boxes at the same time someone just asked for clarification on that answer about the under coopay so I'll just read it directly David it says if you're not a concession card holder and the cost of your medicine is less than $30 and the cost of two boxes is also less than $30 will I pay for one box to get two

46:22 boxes or not no you would pay for the amount of money up to $30 so if my medicine costs me $10 I might have to now pay $20 for it to get those two boxes that's in a small number of situations that's certainly possible right so then sometimes I would get two for the price of one but sometimes I'll get two for the price of two potentially yes right and that

46:53 that's a kind of either end of the scale yes okay terrific so just looking for another question here there are a lot of similar questions with people saying that they weren't being told by pharmacies that they were not eligible because they were not Healthcare card owners there's quite a few of those in the in the chat David and people being told that you know they had to pay sometimes in some cases more than $30 for those medicines

47:26 Greg's asked a question about the prevalence of brand price premium scripts do you does the department have any data that talks about how many scripts attract this brand premium and he comments that you might not know this off the top of your head but perhaps you could provide the answer is that there that's right the department certainly has that information but I don't have it in front of me I'm afraid so if perhaps we can ask you

47:54 to give us that information and then we will provide it back when we provide the chat back happy to do that you talked about the the safety net earlier on and just to be clear that the safety net hasn't changed so if you get your medicines and you make a saving under this program it will just mean that you hit the safety net later in the year or perhaps not at all because you're just not paying as much so it

48:21 won't mean that you miss out on the safety net or in fact that if you do miss out on the safety net that's a good thing because it means you haven't paid as much is that right yeah that's entirely correct so the the at the moment the safety net for the concessional patients as I said is $262 I think it's off the top of my head about 38 scripts for the year add up to equaling that amount of money

48:50 and so you're absolutely right to point out that if if you make some savings as a result of 60-day dispensing that you might not hit the safety net depending on the number of medications you're on if you don't that's great you've saved even more if you do hit the safety net you might hit that later in the year and again from a you know monthly cash flow perspective for for patients who've got to you know pay out

49:17 for a number of other things in terms of kind of rent and electricity and all of those sorts of bills that we all have on a on a day-to-day basis then paying out less every month for the scripts that you need is also a good thing but but the safety net amounts themselves have not changed the government lowered those safety net amounts in the last year or two to you know they've come down over a period of time from over 50 scripts

49:45 required to access the safety net to about 36 or 38 now that $262 great there's a question about whether electronic scripts make any difference to this if you get in an electronic script is the exact same thing no no difference whether it's a paper script or an electronic script it will have the instructions on it from the prescriber as to what sort of script it is for what medication and dose and all the rest of it and that will

50:14 include whether it's a 60-day script or a 30-day script so it doesn't matter whether it's electronic or or paper they're all the same great and if my medicine is prescribed by specialist rather than a GP but it's on the list does it still qualify yep if it's on the list and the the prescriber whether that's a specialist or a GP considers that the recipient of that it meets the criteria in terms of stability of that chronic

50:43 condition then they will write the script for 60 days so it doesn't matter the The Source if you like just that the you know prescriber can write that prescription they will have the option to provide provid 60 days if it's suitable for their patient you know in conversation with the with the patient about what that actually means for them and then the patient can access that 60-day script at the pharmacy right in relation to the safety

51:09 net there's a question from Sandy asking do why do we sorry I think I've Lost You Again oh great Earth yeah I lost you again but I could see the question from Sandy I've you know managed to use my Elite technical skills and actually access the chat for the first time so

51:41 so yes I do understand that the that accessing the the safety net or or proving what you've actually spent in relation to Pharmaceuticals that you do have to collate that manually and that is different to the the way the U Medicare safety networks we would you know we would love to see that come online eventually as more of an automatic process but that's the process that we have at the moment that it is manual to be able to kind of

52:10 demonstrate that the safety nets been met no that's that's fantastic that's very helpful I think we've come almost to the end of the questions David so going to come back to you in a moment I'm just going to do a quick check and then I'm going to ask you if you've got any last kind of comments before we finish up so know you've gone through a lot of different issues there's a question asking about those under co-payment costs does that mean

52:43 that phes set their own prices for some of these prescriptions particularly the brand name but not only they get to choose what the price will be is that right well there is the opportunity for some pharmacies to Discount the cost of those medicines but they decisions that are specifically you know they're commercial decisions if you like for the pharmacies themselves so shiran is asking if you

53:16 don't have a concession card but then you reach the safety net does that affect your 60-day scripts in any way no no it doesn't if you don't have a concession card you have a safety net I think you know I mentioned earlier of just over $1,500 but that does not affect 60-day scripts then the two are not linked the the issuing of a 60-day script from a prescriber is a a clinical decision made by the prescriber the

53:45 ability to access the the safety net once you get to those particularly limit those limits is simply you know a financial one that is Arrangements in place by the government which are entirely separate to the prescribing of the drugs themselves so I think we'll have a last question from Anonymous so for the 30-day limit of non-concessional

54:16 card holders it's this they're just commenting this is not a small number this is the most normal situation since the number of noncon card holders outnumbers the number of concession card holders so there's lots of people who don't have concession cards the medicines on the list are generics for almost all which are less than $15 a box and they're saying that means most people actually won't get any savings is that right because if most of your medicines are in that group and

54:45 they cost less than 15 and a pharmacist can charge them for both boxes there's no saving to be had the savings only if you're in the over $30 in the co-pay well I I would say to that so yes there are a lot of medicines which are under the the $30 General copay but the majority of scripts that are provided in this country I think well in excess of 80% of scripts that are filled are to concession card holders

55:15 and so you can see from that that the volume of medicines provided to concession card holders who are paying their $730 that's where the significant benefit is for consumers so if you're a general patient there are absolutely some benefits for those medicines which are often over $30 the benefit might not be quite as strong if it is under the co-payment of $30 but as the the majority of scripts that are dispensed in this country are to concession card holders around

55:47 about as I said roughly 80% of the volume of scripts dispensed there are significant benefits for the the community in this policy great thanks very much David now I did say come back to you and ask you for your last words so now is your chance what are your overall messages to us all My overall messages are you know to continue to engage with this and if there are some some speed bumps in relation to the prescribers or the

56:19 pharmacists then I'd ask everyone to be patient because this is an education process for the implement mation of a a new policy something that has been you know a significant shift and that will continue to work in good in good faith with all parties to ensure that consumers are able to access the policy as intended and significantly reduce their medicine costs and to help them with our out- of pocket expenses during this time of difficulty in terms of cost of

56:51 living great thank you so much David for your time today today and for being willing to be so transparent with all your answers and and provide us with a lot of information as I said it's probably worth watching this again so this is our website that we've got you can find it at 60-day scripts.com com.au for those of you that are asking for questions about more information about this wanting to know if your medicine is on the list or what you need

57:18 to do if you go to 60days scripts.com Au you'll be able to find all all the information that you need and it links you through the department's website where we the information is not on here so this is a good place for you and your your friends and family to go if they want more information please remember that we record this so in the next few days we will provide this recording back to you so you can watch it again and

57:42 again slow it down speed it up do whatever you like with it you can also share it and stay in touch with us keep sending us in your messages and your questions we use the to have conversations with people like David and his colleagues to make sure the government's getting good information from Australians about what this policy means for them and we love to hear your good news stories too not only the stories of when something didn't work

58:08 because that brightens somebody's day so feel free to send those along as well so thank you to everyone for coming today if you want to keep in touch with us we've got a lot of social media channels you can put your phone up and scan that QR code or you can go to any of those places like LinkedIn or Facebook or Twitter now called X and join in conversations with us about all manner of things so once again a big

58:38 thank you to David you're getting lots of claps there in the I hope you can see those all David people thanking you for all of your hard work today thank you everyone and I hope you have a great rest of your week okay then bye thanks Elizabeth