Australian Institute of Health and Welfare (2022) Palliative care services in Australia, AIHW, Australian Government, accessed 06 July 2022.
Australian Institute of Health and Welfare. (2022). Palliative care services in Australia. Retrieved from https://www.aihw.gov.au/reports/palliative-care-services/palliative-care-services-in-australia
Palliative care services in Australia. Australian Institute of Health and Welfare, 25 May 2022, https://www.aihw.gov.au/reports/palliative-care-services/palliative-care-services-in-australia
Australian Institute of Health and Welfare. Palliative care services in Australia [Internet]. Canberra: Australian Institute of Health and Welfare, 2022 [cited 2022 Jul. 6]. Available from: https://www.aihw.gov.au/reports/palliative-care-services/palliative-care-services-in-australia
Australian Institute of Health and Welfare (AIHW) 2022, Palliative care services in Australia, viewed 6 July 2022, https://www.aihw.gov.au/reports/palliative-care-services/palliative-care-services-in-australia
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In 2020–21, 514,700 people received 1.17 million palliative care-related prescriptions. This section provides information related to these prescriptions and the characteristics of the people who received them over the period 2016–17 to 2020–21. Further information about how palliative care prescriptions are identified through the Pharmaceutical Benefits Scheme (PBS) and the Repatriation Pharmaceutical Benefits Scheme (RPBS) are described below and in the Data Sources section.
The information in this section was last updated in May 2022.
Pharmaceuticals are an important component of care for palliative patients. One of the attributes of palliative care is to ‘provide relief from pain and other distressing symptoms’ (WHO 2020). In the majority of cases, this involves medications being prescribed by the treating clinician.
Palliative care-related medications can be prescribed for patients with ‘an active, progressive, far advanced disease for whom the prognosis is limited and the focus of care is the quality of life’. These medications can be prescribed to anyone with a life-limiting condition, irrespective of their condition or the reason for palliative care (DoH 2016a).
Through the Pharmaceutical Benefits Scheme (PBS) and the Repatriation Pharmaceutical Benefits Scheme (RPBS), the Australian Government subsidises the cost of pharmaceutical products listed on the Schedule of Pharmaceutical Benefits (DoH 2021). In 2004, the Australian Government introduced Pharmaceutical Benefits for Palliative Care, referred to as the PBS Palliative Care Schedule. The PBS Palliative Care Schedule, which lists medication items available for palliative care, was established as a separate schedule but complements the General Schedule to improve access to essential and affordable medications for patients receiving palliative care.
Palliative care patients who are accessing medications listed on the PBS Palliative Care Schedule, can also access medications listed on the General PBS and RPBS Schedules, such as morphine. The same medications may be listed on the PBS Palliative Care Schedule and the General Schedule, however, medications on the PBS Palliative Care Schedule may be listed with larger quantities and/or more script repeats, making them more suitable for use in palliative care (DoH 2016a). This may reduce patient co-payment costs and decrease the frequency of doctor consultations for ongoing symptom management. Given the overlap in medication items listed on the different schedules, and because the PBS Palliative Care Schedule is intended to complement the General Schedule, it is likely that some medicines prescribed for palliative care are prescribed from the General Schedule. These prescriptions are not included in the count of palliative care-related prescriptions in this report.
Palliative care prescriptions can also be identified through the prescriber. Palliative medicine specialists may prescribe medicines for a range of reasons, some of which may be for palliative care, and may prescribe from different schedules. This report includes information on medications prescribed by palliative medicine specialists, from all schedules (Table PBS.7), and are therefore likely to include prescriptions prescribed for both palliative care and non-palliative care reasons.
In some other instances, medications prescribed for palliative care purposes are not captured in this report, such as for private prescriptions, over-the-counter medicines and medicines supplied to public hospital inpatients.
The number of palliative care-related prescriptions increased overall by 28% in the 4 years to 2020–21 (from 908,000 to 1.22 million) but declined by 4.2% in the 12 months to 2020–21, driven by declines in pain relief medications in the 2 years to 2020–21. In contrast, large average annual increases in prescriptions were observed for gastrointestinal and neurological symptoms over the 5 year period (13% and 12% increase, respectively).
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Information on prescription medications presented in this section is sourced from the Pharmaceutical Benefits Scheme (PBS) and the Repatriation Pharmaceutical Benefits Scheme (RPBS). This report largely focusses on prescriptions dispensed from the PBS Palliative Care Schedule, referred to as palliative care-related prescriptions. It also includes information on prescriptions prescribed by palliative medicine specialists, including from the PBS Palliative Care Schedule and the General Schedule. All data are presented by the date of supply, that is, when the prescription was dispensed to the patient.
When interpreting information in this section, it is useful to note that individual prescriptions will vary in the number of doses, the strength of each individual dose and the type of pharmaceutical preparations (such as tablets or injections). This level of detail is not reported here.
It should also be noted that data from 2016–17 onwards are not comparable with previous years. This is due to significant changes to the PBS restriction level from June 2016, as well as new listings of medications on the PBS Palliative Care Schedule (DoH 2016b). See the Data Sources section for further information.
Nationally, 514,700 people were dispensed with at least one palliative care-related prescription in 2020–21, that is 2.0% of the Australian population (or 2,000 per 100,000).
In 2020–21, among people dispensed with palliative care-related prescriptions:
Figure PBS 1.1: This interactive data visualisation shows number and rate of people dispensed with palliative care-related prescriptions, for the 2020–21 financial year s by age[MS1] . The 65-74 age group has the highest number of people dispensed palliative care related prescriptions while the 85 and over age bracket has the highest rate (per 100,000).
Figure PBS 1.2: This interactive data visualisation shows number and rate of people dispensed with palliative care-related prescriptions by remoteness area, for the 2020–21 financial year. Major cities had the highest number of people dispensed with palliative care related prescriptions while Outer regional areas has the highest rate (per 100,000 population) of people receiving prescriptions.
In 2020–21, 1.17 million palliative care-related prescriptions were dispensed, at an average of 2.3 presciptions per person (Table PBS.2).
Medications listed on the PBS Schedule of the Pharmaceutical Benefits Scheme are classified in accordance with the Anatomical Therapeutic Chemical (ATC) Classification System (WHO 2018). Medication types on the Palliative Care Schedule were grouped based on ATC Pharmacological or Therapeutic subgroup (ATC level 2) in previous editions of the Palliative care services in Australia report. However, these codes do not adequately represent palliative care treatment.
For this 2022 report, the method to report types of palliative care prescriptions has been updated, with categories based on the Palliative Care publication of the Australian Therapeutic Guidelines (Therapeutic Guidelines Limited 2021). These ‘medication groups’ represent a clinically-meaningful grouping of medications on the Palliative Care Schedule that are used to treat common palliative care symptoms. These groups are not directly comparable with the ‘medication type’ previously reported. Medication groups, with corresponding ATC codes (levels 2 and 5), can be seen in Table 1 of the Data Sources section.
The 5 medication groups are:
In 2020–21, among people dispensed with a palliative care-related prescription:
Figure PBS 2: This interactive data visualisation shows the number and rate of people receiving palliative care-related prescriptions by clinician type and medication type, by states and territories, for the 2020–21 financial year. New South Wales has the highest number of people receiving prescriptions from all clinicians while Tasmania has the highest rate (per 100,000 population).
Pain management is an integral component of quality palliative care, and pain relieving medications are often used in conjunction with other strategies. Pain can be due to a life-limiting illness, its treatment, debility or comorbid illnesses (Therapeutic Guidelines Limited 2021).
In 2020–21, the most common type of pain relief medication was non-steroidal anti-inflammatory and antirheumatic products (60%), followed by other analgesics and antipyretics (28%) and opioids (13%). Around 2 in 5 (42%) anti-inflammatory and antirheumatic products and almost half (48%) of other analgesics and antipyretics palliative care-related prescriptions were repeat scripts, compared with almost 1 in 6 (16%) opioids prescriptions (Table PBS.10).
Anti-inflammatory and antirheumatic product prescriptions were dispensed at the highest rate of the 3 medication subgroups across all states and territories, ranging from 2,200 per 100,000 in the New South Wales to 4,000 per 100,000 in Tasmania. Across most states and territories, other analgesics and antipyretic prescription rates were higher than for opioids, except for South Australia and Tasmania (Figure PBS.3).
Figure PBS 3: This interactive data visualisation shows the number and rate (of pain relief palliative care-related prescriptions by pain relief medication type, by states and territories, for the 2020–21 financial year. Tasmania had the highest rate (per 100,000 population) of pain relief prescriptions while New South Wales had the highest number of prescriptions. Anti-inflammatory and anti-rheumatic products were the most common pain relief medication across all states and territories.
Palliative medicine specialists routinely prescribe medicines for palliative care, either through the Palliative Care Schedule, General Schedule or other schedules. Some palliative care specialists may also hold other medical specialisations (e.g. oncology) and prescriptions may be issued for patients other than those receiving palliative care.
In 2020–21, 324,400 prescriptions were prescribed by palliative medicine specialists, with the vast majority (96%) of these prescriptions from the General Schedule. See Table PBS.7 for more information, including information about expenditure.
Figure PBS 4: This interactive data visualisation shows the number and rate (per 100,000 population) of palliative care-related prescriptions by medication type and prescribing clinician, for the 2020–21 financial year. The highest number of palliative care-related prescriptions were prescribed for pain relief followed by gastrointestinal for all clinicians.
People usually contribute a co-payment for prescriptions, which will differ depending on the persons entitlement, in particular whether they hold a concession card (including pensioners and those with health care cards) or repatriation card (DVA Veteran Card holders) or not. Co-payment amounts are determined by a combination of patient category and dispensed price of the medication. For example, as at 1 January 2021, the maximum patient co-payment per PBS subsidised prescription was $6.60 for concession and repatriation card holders and $41.30 for general card holders (those with a Medicare card but no concession cards; DoH 2021). If a prescription is priced below the relevant co-payment threshold, or there is no government subsidy on the dispensed price, the consumer pays the full price and the prescription is classified as an under co-payment prescription. If a prescription is priced over the threshold, it is considered ‘over co-payment’ or a subsidised prescription.
In 2020–21, almost 3 in 4 (72%) palliative care-related prescriptions were subsidised (over co-payment) prescriptions, with gastrointestinal symptoms, respiratory symptoms and psychological symptoms accounting for the highest proportion of subsidised prescriptions (95%, 93% and 89%, respectively; see Table PBS.4). Medications for pain relief and neurological symptoms had the highest proportion of under co-payment prescriptions (30% and 21%, respectively).
The vast majority (92%) of subsidised palliative care prescriptions were dispensed to people with concession cards, while under co-payment prescriptions were exclusively claimed by general card holders.
See Data Sources section for further details on the subsidised and total prescriptions presented in this report compared with previous releases.
In the 5 years to 2020–21, the number of palliative care-related prescriptions dispensed increased overall by 28% (from 908,100 to 1.17 million), however in recent years this increase has slowed and declined in the 12 months to 2020–21. The largest increase over this period occurred between 2016–17 and 2017–18 (25% increase), then slowed in the 12 months to 2018–19 (6.8% increase), then stablised and declined (by 4.2%) in the 12 months to 2020–21 (Figure PBS.5). This trend was largely driven by changes in the number of medications prescribed for pain relief, which makes up 89% of all palliative care-related prescriptions.
Prescriptions increased for all types of palliative care-related medications between 2016–17 and 2020–21 (Table PBS.5). The largest average annual increase over the 5-year period was for prescriptions for gastrointestinal symptoms (13% increase), followed by neurological symptoms (12%) and the smallest increase was for pain relief (5.5%). The number of medications prescribed for pain relief peaked in 2018–19 (1.11 million) and has decreased since (1.04 million in 2020–21).
Palliative care-related prescribing by all clinicians has increased overall between 2016–17 and 2019–20, with a slight dip in 2020–21. However, over this period there have been slightly different patterns by specific prescribers, particularly in the 12 months to 2020–21. The number of prescriptions by GPs, the largest prescriber of palliative-care related prescriptions, increased steadily between 2016–17 and 2019–20 before declining by 4.7% in the 12 months to 2020–21. This decrease was driven by changes in prescriptions of pain relief medications, which may be due to some of these items being delisted in 2020–21. For palliative medicine specialists, the number of prescriptions also steadily increased over the 5 year period, with the largest increases occurring in the 12 months to 2020–21 (30% increase compared with 13% increase between 2018–19 and 2019–20). For other clinicians, the numbers remained relatively stable over the 4-year period to 2020–21.
By looking at monthly PBS data, we can assess the effect of the public health response to the COVID-19 pandemic on PBS service utilisation during 2020 and 2021. In March 2020, there was a 19% increase in palliative care-related prescriptions from February 2020 levels and 13% higher than the corresponding period in 2019. Following this spike, there was a 20% drop in April 2020 from March 2020 and 7% drop from April 2019 levels (Table PBS.12).
This pattern was observed across most medication types, not only those relating to palliative care, and was largely due to changes in consumer behaviour coinciding with the introduction and then easing of restrictions during the COVID-19 pandemic in 2020. Also, in response to this dramatic increase in demand for medicines during early March which resulted in reported shortages in medicines, the Australian Government implemented temporary changes to medicines regulation to support continued access to PBS medicines (AIHW 2020).
Between July and December 2020 the number of prescriptions was relatively similar to previous years, before another large drop was observed for most months between January to May 2021 (3–15% below the 2019 levels for the corresponding months). These trends were largely driven by trends in the number of prescriptions for pain relief by GPs.
For more information see: Impacts of COVID-19 on Medicare Benefits Scheme and Pharmaceutical Benefits Scheme: quarterly data (AIHW 2021).
Figure PBS 5.1: This interactive data visualisation shows the number and rate of palliative care-related prescriptions by medication type and prescribing clinician[DK1] [MS2] , for each year between 2016-17 to 2020-21. It shows the total number of palliative care prescriptions from all clinicians increasing each year to 2019–20 and then declining in 2020–21.
Figure PBS 5.2: This interactive data visualisation shows the number and rate of palliative care-related prescriptions by medication type and prescribing clinician, for each month between January 2019 to June 2021. It shows that over the period there have been large spikes and dips, in particular a large increase in March 2020 (compared with March 2019 levels) and in January 2021 (compared with corresponding levels in previous years).
AIHW (Australian Institute of Health and Welfare) 2021. Impacts of COVID-19 on Medicare Benefits Scheme and Pharmaceutical Benefits Scheme: quarterly data. Canberra: AIHW. Viewed 1 July 2021.
DoH (Department of Health) 2011. Pharmaceutical benefits Benefits scheme Scheme collection of under co-payment data. Canberra: DoH. Viewed 1 July 2021.
DoH 2016a. Access to medicines for palliative care on the PBS. Canberra: DoH. Viewed 1 July 2021.
DoH 2016b. Schedule of Pharmaceutical Benefits: Summary of Changes. Effective 1 June 2016. Canberra: DoH. Viewed 1 July 2021.
DoH 2021. Repatriation Schedule of Pharmaceutical Benefits (RPBS) Items. Canberra: DoH. Viewed 11 May 2022.
Therapeutic Guidelines Limited 2021. Therapeutic Guidelines: Palliative Care. Melbourne: Therapeutic Guidelines Limited. Viewed 30 July 2021.
WHO (World Health Organization) 2018. ATC Structure and principles. WHO. Viewed 6 July 2021.
WHO 2020. Global Atlas of Palliative Care, 2nd Ed. London, UK: WHO.
Services Australia (formerly the Australian Government Department of Human Services) collects administrative data in processing prescriptions dispensed under the PBS/RPBS and provides these data to the Australian Government Department of Health (Health). Information collected includes age, sex and postcode of the patient, details of the prescribed and dispensed medication (such as where medicines are dispensed – community pharmacies, hospitals, etc.). The PBS/RPBS data, maintained by Health, has been used as the data source in this section.
Only those medications listed on the Palliative Care Schedule of the PBS, and medications prescribed by palliative medicine specialists, are included in this section; the former are referred to as palliative care-related prescriptions. The number of people provided with these prescriptions, their characteristics, and the prescription costs funded by the PBS and RPBS are also included.
Previously, the Palliative care services in Australia report has defined types of palliative-care related medicines by categories based on the ATC classification system (see the World Health Organization Collaborating Centre for Drug Statistics methodology for further information on the ATC classification system; WHO 2018).
For the 2022 Palliative care services in Australia report, the method of reporting types of palliative care related prescriptions has been updated, with new categories developed based on the Palliative Care publication of the Australian Therapeutic Guidelines (Therapeutic Guidelines Limited 2021). These categories represent a clinically-meaningful grouping of palliative care symptoms that are often managed with medications listed on the PBS/RPBS Palliative Care Schedule.
Table 1 lists the medication items from the Palliative Care Schedule with their corresponding medication groups and ATC codes at levels 2, 3 and 5. The items listed are those dispensed from the Palliative Care Schedule during the specific years included in this report (2016–17 to 2020–21).
Note, that the medication types (at the ATC level 2) in previous editions of this report are not directly comparable with the ‘medication group’ presented in this report.
Note that most of these medicines are listed in multiple areas of the Schedule of Pharmaceutical Benefits and are not specific to the Palliative Care Schedule. Data extracted using the ATC codes for the Palliative care services in Australia report for medication groups was filtered by program type (Palliative Care Schedule) to report on all palliative care-related prescriptions.
* These medicines are included in the report, noting that they were first listed on the PBS Palliative Care Schedule on 1 June 2021 and therefore only include prescriptions for 1 month (to 30 June 2021).
** Hyoscine butylbromide can also be used to manage respiratory secretions.
*** These PBS items are listed on the PBS as Restricted Benefit which can only be prescribed for specific therapeutic uses.
PBS/RPBS data do not capture the following:
For demographic tables, patient characteristics are determined at a single point in each year, ensuring each person is only counted once in the year.
State and territory are determined according to the patient’s residential postcode as recorded on the Consumer Directory. If the patient’s state or territory is unknown, then the state or territory of the pharmacy supplying the item is reported.
All data are presented by the date of supply, that is, when the prescription was dispensed to the patient.
Until 1 April 2012, PBS and RPBS prescription data supplied to the AIHW by the Department of Health excluded prescriptions costing less than the patient co-payment amount (under co-payment). From 1 April 2012, changes to the National Health Act 1953 required pharmacies to supply data for prescriptions that are priced below the patient co-payment level to Services Australia, formerly Department of Human Services (DoH 2011). Under co-payment prescription data were then supplied in PBS/RPBS Palliative Care datasets and were incorporated in the same tables as subsidised prescription data, but were often reported separately. In the Palliative care services in Australia 2022 report (including 2016–17 to 2020–21 PBS/RPBS data), under co-payment and subsidised data are now combined in most tables. An additional table by patient beneficiaries shows the palliative care data by co-payment type in a single table for 2020–21 (Table PBS.4.), rather than including this split in every table.
On 1 June 2016, as part of the Post-market Review of Authority Required PBS Listings, changes were made to items listed on the Palliative Care Schedule. The restrictions for a number of Palliative Care Schedule items were changed and some medications were added or deleted. The restriction level of certain Palliative Care Schedule items, specifically those in the ‘pain relief’ and ‘gastrointestinal symptoms’ categories, were changed, in many cases from ‘Authority Required (STREAMLINED)’ to ‘Restricted Benefit’, reducing the level of restriction. Certain versions of medications were delisted due to initial and continuing treatment restrictions being simplified and merged under a single item code. Prescriptions written prior to 1 June 2016 for deleted item codes remained valid for a 12-month transition period. Some pain relief items were also added, specifically buprenorphine, resulting in an increase in prescriptions in this category.
Due to these changes, data presented in this report from 2016–17 onwards are not comparable with previous years. These changes particularly affect medications in this report that come under the ‘pain relief’ and ‘gastrointestinal symptoms’ categories.
Department of Health (2021) The Pharmaceutical Benefits Scheme. 4. Patient Charges, Department of Health, Australian Government, accessed 27 May 2021.
Therapeutic Guidelines Limited (2021) Therapeutic Guidelines: Palliative Care, Therapeutic Guidelines Limited, accessed 30 July 2021.
World Health Organization (2018) ATC Structure and principles. World Health Organisation, accessed 6 July 2021.
Palliative care-related prescriptions
Palliative care-related prescriptions are defined in this section as medications listed in the PBS Palliative Care Schedule. The information on prescription medicines in this section has been sourced from the processing of the PBS/RPBS and refers to medications prescribed by approved prescribers and subsequently dispensed by approved suppliers (community pharmacies or eligible hospital pharmacies). Consequently, it is a count of medications dispensed rather than a count of prescriptions written by clinicians.
Under the PBS/RPBS the cost of prescription medicines is subsidised by the Commonwealth government. Patients are classified as either general or concessional, and are required to pay a patient co-payment towards the cost of their prescription according to their entitlement. At 1 January 2021 the co-payment was $41.30 (general) and $6.60 (concessional).
A PBS/RPBS prescription is subsidised when the dispensed price of a medication exceeds the patient co-payment. The PBS and RPBS covers the difference between the full cost of the medication and the patient co-payment.
Under co-payment prescription
A prescription priced below the co-payment as defined in the National Health Act 1953. A PBS/RPBS prescription is classified as under co-payment when the dispensed price of the prescription does not exceed the patient co-payment, and the patient pays the full cost of the medication.
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