[PDF]Vial sharing - Rackcdn.comhttps://e76bb9fd1f54a7a912eb-40f6ec802f763655ee14c32dfe77820e.ssl.cf4.rackcdn...
3 downloads
313 Views
317KB Size
‘Monetising’ vial ‘excess’ or ‘wastage’ 50mg ‘excess’
50mg ‘excess’
50mg ‘excess’
50mg ‘excess’
250mg vial
250mg vial
250mg vial
250mg vial
4x50mg
combined
Patient prescribed and administered 200mg dose
Patient prescribed and administered 200mg dose
Patient prescribed and administered 200mg dose
One simple example
Someone is paying
Five patients are treated with four vials.
The practice of ‘monetising’ vial ‘excess’ or ‘wastage’ is evident in prescription data.
The manufacturer supplies and is paid for four doses - provider might claim five through the PBS. It could claim four through the PBS and charge the fifth to a private patient. Under ‘Efficient Funding of Chemotherapy’ rules the PBS pays for the most efficient combination of vials to get the required dose – this can involve a single or multiple vials for one patient.
PBS data produced by the Department of Human Services (DHS) can differ from commercial data – DHS data revealing funded PBS services can be much higher than vials shipped according to commercial data.
In this example, all five patients are prescribed and dispensed 200mg doses with the medicine supplied in a single 250mg vial. The 200mg dose means each of the four purchased 250mg vials produces a 50mg ‘excess’.
Patient prescribed and administered 200mg dose
Patient prescribed and administered 200mg dose
Under PBS rules, and for many cancer medicines, the PBAC considers this 50mg excess ‘wastage’. The manufacturer is not reimbursed for it and forced to provide it free.
The fifth patient is prescribed and dispensed the combined ‘excess’. This excess is not reimbursed but the government might still pay through the PBS or the patient is charged privately.
Manufacturers can be ‘hit’ twice The government pays for this ‘monetisation’. Companies can also be forced to rebate it to government through spending and utilisation caps based on DHS data – effectively it is a ‘double’ price cut because companies supply the ‘excess’ for free then can pay for its use through rebates.
