Data source

Pharmaceutical Benefits Scheme and Repatriation Pharmaceutical Benefits Scheme data

The Commonwealth government subsidises the cost of prescription medicines through two schemes, the Pharmaceutical Benefits Scheme (PBS) and the Repatriation Pharmaceutical Benefits Scheme (RPBS) for eligible war veterans and their dependants.

People fall into two broad classes: general and concessional. Concessional beneficiaries include pensioners, Health Care card holders, Commonwealth Seniors Health card holders and Veterans card holders. Under the PBS/RPBS, the patient is required to contribute a co-payment which is indexed annually; $38.80 for general patients and $6.30 for those with a concession card as of 1 January 2017. If a medicine is priced below the relevant co-payment threshold the consumer pays the full price and the prescription is classified as ‘under co-payment’. If a medicine is not listed in the PBS Schedule of Pharmaceutical Benefits, the consumer pays the full price as a private prescription, and the data is not included in the presented tables.

The collection of under co-payment prescription data for the PBS and RPBS commenced on 1 April 2012. The data collected is identical to that collected for subsidised prescriptions. Prior to 2012 the only source of under co-payment data was a survey of pharmacies funded by the Department of Health (see the information on DUSC below). Time series presentation of survey data with the under co-payment data is not possible as the DUSC data may have been an underestimate of prescription volumes.

Most prescriptions for General Schedule medicines (Section 85) are dispensed through community pharmacies, but PBS is also available in private hospitals and through eligible public hospitals to patients on discharge and day patients. In addition, a number of drugs are distributed under alternative arrangements where these are considered more appropriate (Section 100). Examples are the Highly Specialised Drugs program and General Schedule medicines that are supplied directly to indigenous patients via Aboriginal Health Services in remote areas of Australia (AHS program).

PBS/RPBS does not include the following:

  • Private prescriptions
  • Over the counter medicines
  • Medicines supplied to public hospital inpatients

The Department of Human Services (DHS) processes all prescriptions dispensed under the PBS/) and Repatriation Pharmaceutical Benefits Scheme (RPBS and provides this data to the Department of Health.  The PBS/RPBS data maintained by Health has been used to produce this report. Information collected includes the characteristics of the person who is provided with the prescription, the medication prescribed (for example, type and cost), the prescribing practitioner and the supplying pharmacy (for example, location). The figures reported relate to the number of mental health-related prescriptions processed by DHS in the reporting period, the number of people provided with the prescriptions and their characteristics, as well as the prescription costs funded by the PBS and RPBS (see the Expenditure section).

Although the PBS and RPBS data capture most of the prescribed medicines dispensed in Australia, these data have the following limitations:

  • The number of patients dispensed with under co-payment prescriptions cannot be derived by subtracting the number of patients receiving subsidised prescriptions from the total number of patients shown in the tables. Patients may receive both subsidised and under co-payment prescriptions which means there is duplication of some people in tables PBS.2–5.
  • Programs funded by the PBS/RPBS that do not use the DHS online processing system include:
    • Aboriginal health services program
    • Opiate Dependence Treatment Program.

Only one of these has a bearing on the mental health-related prescriptions data published in the Prescriptions and Expenditure sections: the Aboriginal health services program. Most affected are the data for Remote and Very remote areas and the data for the Northern Territory. Consequently, the mental health-related prescriptions data in these sections will not fully reflect Australian Government expenditure on mental health-related medications.

  • All data is presented by the date of supply, that is, when the prescription was dispensed to the patient. For demographic tables, patients/prescriptions are allocated to the last category in which the patient appears. The reporting category most affected by this will be age group, as age is calculated at the time of supply, and patients’ ages will be one year greater for prescriptions supplied after their birthday than before it.
  • State and territory are determined by the Department of Health according to the patient’s residential address as recorded on the Medicare Enrolment file. If the patient’s state or territory is unknown, then the state or territory of the pharmacy supplying the item is reported.

The ATC classification version used is the primary classification as it appears in the PBS Schedule of Pharmaceutical Benefits. This can differ slightly from the WHO version (WHO 2016 ). There are two differences between the WHO ATC classification and the PBS Schedule classification that have a bearing on mental health data. Prochlorperazine is regarded as another antiemetic (A04AD) in the PBS Schedule while it is an antipsychotic according to the WHO classification. This means that information on Prochlorperazine will not appear in the data provided as it is not classed as an N code in the PBS Schedule. Lithium carbonate, on the other hand, is classified as an antidepressant in the PBS Schedule while it is an antipsychotic according to the WHO classification. This means that lithium carbonate will appear in the data as an antidepressant rather than an antipsychotic (see the following table).

Data Source PBS.1: Differences between the WHO ATC classification and the PBS Schedule of Pharmaceutical Benefits classification
Drug name WHO ATC Code PBS Schedule Code Scripts dispensed in 2016–17(a(
Prochlorperazine N05AB04 A04AD 542,363
Lithium carbonate N05AN01 N06AX 106,061

(a) Prescriptions data using date of service basis.
Source: DHS (Department of Human Services) 2017.

Drug Utilisation Sub-Committee (DUSC) database

Previous Mental health services in Australia prescription data products included data source from the DUSC database. From 1 April 2012, following the implementation of the under co-payment data collection, the DUSC-sponsored Pharmacy Guild survey ceased to be the source of under co-payment prescription data. As a result, time series data prior to 2012 has been removed from the tables as the previous survey methodology may be an underestimate of the volumes of under co-payment prescriptions.


References

DHS (Department of Human Services) 2017. Pharmaceutical Benefits Schedule Item Reports website , Canberra: Commonwealth of Australia. Viewed 10 November 2017.

DoH (Department of Health) 2014. Pharmaceutical Benefits Scheme Collection of Under Co-payment Data . Viewed 1 February 2017.

WHO (World Health Organization) 2016. ATC: Structure and principles . Oslo: WHO Collaborating Centre for Drug Statistics Methodology. Viewed January 2017.