Palliative care services in Australia

Web report

Last updated: 25 May 2023

Media release

AIHW

Australian Institute of Health and Welfare (2023) Palliative care services in Australia, AIHW, Australian Government, accessed 01 October 2023.

APA

Australian Institute of Health and Welfare. (2023). Palliative care services in Australia. Retrieved from https://www.aihw.gov.au/reports/palliative-care-services/palliative-care-services-in-australia

MLA

Palliative care services in Australia. Australian Institute of Health and Welfare, 25 May 2023, https://www.aihw.gov.au/reports/palliative-care-services/palliative-care-services-in-australia

Vancouver

Australian Institute of Health and Welfare. Palliative care services in Australia [Internet]. Canberra: Australian Institute of Health and Welfare, 2023 [cited 2023 Oct. 1]. Available from: https://www.aihw.gov.au/reports/palliative-care-services/palliative-care-services-in-australia

Harvard

Australian Institute of Health and Welfare (AIHW) 2023, Palliative care services in Australia, viewed 1 October 2023, https://www.aihw.gov.au/reports/palliative-care-services/palliative-care-services-in-australia

Latest edition

Palliative care-related medications

In 2021–22, 453,300 people received 1.3 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 2017–18 to 2021–22. 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 2023.

Data on this page Expand

Identifying palliative care-related prescriptions in the Pharmaceutical Benefits Scheme Expand

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 2016).

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 (DHAC 2023). 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 complementing 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 2016). 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.

Key points

In 2021–22:

there were 1.3 million palliative care-related prescriptions provided to 453,300 people, an average of 2.8 prescriptions per person
those aged 65 and over accounted for 1 in 2 (53%) people who were prescribed palliative care-related prescriptions
8 in 10 (79% or 1.0 million) palliative care-related prescriptions were for pain relief
general practitioners prescribed the majority (89%) of palliative care-related prescriptions, with the vast majority of these for pain relief
palliative medicine specialists were more likely to prescribe medications for gastrointestinal, respiratory, and psychological symptoms while medications for neurological symptoms were more likely to be prescribed by other clinicians
Australian Government expenditure for palliative care-related prescriptions was $34.4 million, at an average of $75.9 per patient.

Between 2017–18 and 2021–22, the number of people dispensed with palliative care-related prescriptions declined by 18% overall, with the annual rate of decline steeper in 2021–22 than in 2019–20 (12% compared with 3.7%, respectively). However, the number of palliative care-related prescriptions has remained relatively stable over this period, leading to increases in the number of prescriptions per person from 2.1 to 2.8 over this period.

Who were dispensed these prescriptions?

In 2021–22, 453,300 people were dispensed with at least one palliative care-related prescription nationally, equating to 1.8% of the Australian population (or 1,800 per 100,000 population). Among people dispensed with palliative care-related prescriptions (Figure PBS.1):

More were females (54%) – 245,300 compared with 207,900 for males, equating to 1,900 per 100,000 females and 1,600 per 100,000 males.
1 in 2 (53%) were aged 65 and over – increasing from 5.7% to 20% between the ages 25 and 74, and then declining to 14% for those aged 85 and over. However, taking into account the size of the population in each age group, those aged 85 and over had the highest prescription rate (11,700 per 100,000), 2–3 times as high as those in 65–74 and 75–84 age groups.
Those living in Inner regional and Outer regional areas were more likely to be dispensed with palliative care-related prescriptions (2,300 per 100,000 in each) than those in other areas (1,600 per 100,000 in Major cities and 1,400 per 100,000 in Remote and very remote areas combined). Note that medicines distributed through Remote Area Aboriginal Health Services are not included in these data. This could contribute to the low rate observed in remote areas.
The rate varied across the states and territories, ranging from 1,100 per 100,000 in Northern Territory to 2,300 per 100,000 in Tasmania.

Figure PBS.1: People who received prescriptions from Palliative Care Schedule, 2021–22

Types of palliative care-related prescriptions Expand

In 2021–22, 1.3 million palliative care-related prescriptions were dispensed, at an average of 2.8 prescriptions per person. Among these palliative care-related prescriptions (Figure PBS.2):

On average, more prescriptions were dispensed to females than males – 2.9 prescriptions per females and 2.7 per males, consistent with the higher number of females receiving these prescriptions.
Number of prescriptions per person increased steadily from age 15 (1.6 prescriptions per person) to age 84 (3.2 prescriptions per person) and then dropped slightly to 3.1 prescriptions per person for those aged 85 and over. Those aged 15 and under had an average of 2.1 prescriptions per person.
8 in 10 (79%) prescriptions were for pain relief – this equated to 1.0 million prescriptions or 3,900 per 100,000 population. The next most common prescription type was for gastrointestinal symptoms (123,000 prescriptions; 480 per 100,000), followed by prescription for neurological symptoms (102,000 prescriptions; 400 per 100,000). For further details on these prescriptions, see Table 1 in the Data sources.
Tasmania had the highest rate of prescriptions dispensed, 1.5 times the national average rate – 7,300 and 4,900 per 100,000 population, respectively. Prescriptions for pain relief accounted for the highest rate of palliative care-related prescriptions in all states and territories, ranging from 2,400 per 100,000 population in Northern Territory to 6,200 per 100,000 in Tasmania.

Figure PBS.2: Prescriptions from Palliative Care Schedule, 2021–22

Pain relief medications

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 (see Therapeutic Guidelines: Palliative Care for further information).

In 2021–22, the most common type of pain relief medication was opioids (37%), followed by other analgesics and antipyretics (33%) and non-steroidal anti-inflammatory and antirheumatic products (30%). In previous years, non-steroidal anti-inflammatory and antirheumatic accounted for the majority of pain relief medications (60%, compared with 13% for opioids in 2020–21). This more equal share of pain relief sub-group medications in 2021–22, was due to the large annual decline in non-steroidal anti-inflammatory and antirheumatic prescriptions (52% decline from 621,500 to 300,700 between 2020–21 and 2021–22), and the steep annual increase in opioids (almost tripled from 131,500 to 372,000; Table PBS.10).

This increase in opioids was driven by increases in morphine (accounted for 22% of this increase) and new listings for oxycodone (for the management of severe disabling pain) from July 2021 (accounted for 45% of this increase). Most of the decline in non-steroidal anti-inflammatory and antirheumatic prescriptions was due to diclofenac being de-listed from the Palliative Care Schedule from June 2021, as this prescription can be obtained from the General Schedule with the same or similar restriction/clinical criteria and number of quantities/repeats (DoH 2021a; DoH 2021b; DoH 2021c; NPS Medicinewise 2021).

Among all pain relief prescriptions, almost 1 in 2 (48%) anti-inflammatory and antirheumatic and other analgesics and antipyretics palliative care-related prescriptions were repeat scripts, compared with about 1 in 10 (11%) opioids prescriptions (Table PBS.5).

There were variations across the states and territories in the prescription rates for pain relief medications. Consistent with the patterns observed above for pain relief medications overall, Tasmania had the highest rates for non-steroidal anti-inflammatory and antirheumatic prescriptions and opioids, while New South Wales had the highest rate for other analgesics and antipyretics. Northern Territory had the lowest rate for opioids and other analgesics and antipyretics and South Australia for non-steroidal anti-inflammatory and antirheumatic prescriptions (Figure PBS.3).

Figure PBS.3: Prescriptions for pain relief from Palliative Care Schedule, by medication group (ATC level 3) and state and territory, 2021–22

Who prescribed these medications?

In 2021–22 (Figure PBS.4):

General practitioners (GPs) prescribed the majority (89%) of palliative care-related prescriptions, while palliative medicine specialists prescribed 1.4% of medications. The remainder (10%) were prescribed by other clinicians (including medical specialists from other disciplines and nurse practitioners).
8 in 10 prescriptions (82%) by GPs were for pain relief – palliative medicine specialists and other clinicians also predominately prescribed for pain relief, but to a lesser extent (69% and 60%, respectively).
Palliative medicine specialists were more likely than GPs and other clinicians to prescribe medications for gastrointestinal symptoms (14% vs 9.6% and 11%), for respiratory symptoms (2.9% vs 1.3% and 1.5%), and for psychological symptoms (5.2% vs 1.2% and 2.4%). Other clinicians were 3–4 times as likely to prescribe medications for neurological symptoms than GPs and palliative medicine specialists (25% compared with 6.2% and 8.4%, respectively).
There were some variations across the states and territories in prescriptions from GPs, ranging from 85% in Western Australia to 92% in Tasmania. This lower proportion in Western Australia was due to prescriptions from other clinicians accounting for a higher proportion (12%), which was also the case for Victoria (13%) and Australian Capital Territory (12%).

Vast majority of prescriptions by palliative medicine specialists were from the General Schedule Expand

How many prescriptions were subsidised and who predominantly received these? Expand

People usually contribute a co-payment for prescriptions, which will differ depending on the persons entitlement, in particular whether they are hold a concession card (including pensioners and those with health care cards) or repatriation card (Department of Veterans' Affairs (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 2022, the maximum patient co-payment per PBS subsidised prescription was $6.80 for concession (including repatriation) card holders and $42.50 for general card holders (those with a Medicare card but no concession cards; DHAC 2022). 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 2021–22, 4 in 5 (82%) palliative care-related prescriptions were subsidised (over co-payment) prescriptions, with respiratory symptoms accounting for the highest proportion of subsidised prescriptions (92%) and neurological symptoms the lowest proportion (68%), as this prescription had the highest proportion of under co-payment prescriptions (32%; Table PBS.3).

The vast majority (94%) of subsidised palliative care prescriptions were dispensed to people with concession cards, while under co-payment prescriptions were exclusively claimed by general card holders (Table PBS.3). Note that in this release, repatriation card holders have been combined into concessional category, due to small counts of under co-payment prescriptions for repatriation card holders in some medication groups for the PBS Palliative Care Schedule. Prior to 2023, the AIHW reported separately on repatriation and concessional card holders.

See Data sources section or further details on the subsidised and total prescriptions presented in this report compared with previous releases.

How have these prescriptions changed over time?

In the 5 years to 2021–22, the number of people dispensed with palliative care-related medications had declined by 18% (from 551,200 to 453,300 people between 2017–18 and 2021–22, see Figure PBS.5). Since 2018–19 the rate of decline had increased each year from a decline of 3.7% in the 12 months to 2019–20 to a decline of 12% in the 12 months to 2021–22. However, for most of this period, the number of palliative care-related prescriptions dispensed had remained relatively stable (1.21–1.26 million prescriptions in 2018–19, 2019–20 and 2021–22), except in 2020–21 where prescriptions dispensed declined by 4.2% from 2019–20, but still 2.9% higher than in 2017–18. This decline in the number of prescriptions in 2020–21 may reflect changes in consumer behaviour coinciding with the introduction and then easing of restrictions during the COVID-19 pandemic, resulting in high demand for medicines in the early months of the pandemic resulting in short-term shortages in medicines (see 2022 edition of this report for further details on the impacts of COVID pandemic).

The number of prescriptions per person had increased, from 2.1 in 2017–18 to 2.8 in 2021–22, reflecting declines in the number of people dispensed with palliative care-related prescriptions and prescriptions increasing over this period.

The declines in the number of people dispensed with palliative care-related medications was driven by declines in the number of people receiving pain relief medications that accounted for 79% of all prescriptions – the number of people receiving pain relief medications fell by 29% in the 5 years to 2021–22 (and 21% in the 12 months to 2021–22). Meanwhile, the number of people receiving prescriptions for all other symptoms increased over this period – 2-fold increase for gastrointestinal prescriptions, 3-fold increase for psychological symptoms and 7-fold increase for neurological symptoms.

Consistent with these patterns, palliative care prescribing by most clinicians had increased between 2017–18 and 2021–22, except for GPs. For palliative medicine specialists, prescriptions dispensed increased steeply from 2019–20 – 30% increase in the 12 months to 2020–21 and almost 3-fold increase in the 12 months to 2021–22, reflecting that palliative medicine specialists were more likely to prescribe prescriptions for gastrointestinal, psychological, and neurological symptoms. For other clinicians, number of prescriptions dispensed was relatively stable in the 4 years to 2020–21 but rose steeply by 41% in the 12 months to 2021–22. In contrast, the number of prescriptions from GPs had been falling in 2020–21, reflecting declines in the number of people prescribed with pain relief medications that accounted for the majority of prescriptions by GPs (Figure PBS.5).

As shown in Figure PBS.5 and Table PBS.10, prescriptions increased for most types of palliative care-related medications between 2017–18 and 2021–22:

9-fold increase in prescriptions for neurological symptoms (from 11,000 in 2017–18 to 16,400 in 2020–21, and then increased to 102,000 in 2021–22), due to expanded indications and reduced authority requirements for Clonazepam under the neurological symptoms antiepileptics medications in 2021–22.
2-fold increase for gastrointestinal symptoms (from 64,300 to 123,000), largely driven by the increase of Metoclopramide due to the new form (tablet) with reduced authority requirements.
2-fold increase for psychological symptoms (8,600 to 17,400), mainly driven by the new listing drugs of Haloperidol introduced in 2020–21.
More modest increases for respiratory symptoms (from 11,700 to 16,500 between 2019–20 and 2021–22).

However, prescriptions for pain relief had been declining since 2018–19 (from 1.11 million to 996,200 in 2021–22), driven by steep falls in prescriptions of non-steroidal anti-inflammatory and antirheumatic (from 802,800 in 2018–19 to 300,700 in 2021–22). In the 12 months to 2021–22, there had been considerable changes to pain relief medications. While the number of pain relief medications had declined by 4.2% overall since 2020–21, non-steroidal anti-inflammatory and antirheumatic prescriptions had fallen by 52% (from 621,500 to 300,700 due to Diclofenac being de-listed) and opioids had almost tripled (from 131,500 to 372,000 due to the addition of Oxycodone products). For further details on recent changes to the Palliative Care Schedule see Australian Department of Health and Aged Care, The Pharmaceutical Benefits Scheme website.

Figure PBS.5: Trends in prescriptions from Palliative Care Schedule and people receiving them, 2017–18 to 2021–22

How much was spent on these medications?

During 2021–22:

$34.4 million was paid nationally in benefits for medications included on the Palliative Care Schedule, this was an increase of 69% (in current prices) from $20.4 million in 2017–18 or a 54% increase after adjusting for inflation (in real terms; Table PBS.12). The annual increase in this expenditure was steeper in 2021–22, than in previous years (43% increase compared with annual increases of 1.7% in 2019–20 and 6.4% in 2020–21 after adjusting for inflation; Table PBS.12).
Nationally, the cost per person dispensed with at least one palliative care-related prescription was $76 – this ranged from $48 per patient in Northern Territory to $100 per patient in Tasmania (Table PBS.11), consistent with the prescription rate in each state and territory, where Tasmania had the highest and Northern Territory the lowest (Table PBS.1).
Pain relief prescriptions made up 87% of this expenditure ($30 million), followed by prescriptions for gastrointestinal symptoms (8.1% or $2.8 million), and prescriptions for neurological symptoms (2.8% or $962,500; Table PBS.12). The proportion of benefits paid for pain relief medications ranged from 84% in South Australia and Western Australia to 94% in Australian Capital Territory (Table PBS.11).

References Expand

Data sources Expand

Pharmaceutical Benefits Scheme and Repatriation Pharmaceutical Benefits Scheme data

Services Australia (formerly the Australian Government Department of Human Services) collects administrative data in processing prescriptions dispensed under the Pharmaceutical Benefits Scheme (PBS) and Repatriation Pharmaceutical Benefits Scheme data (RPBS), and provides these data to the Australian Government Department of Health and Aged Care. 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, and so on). The PBS/RPBS data, maintained by the Department of Health and Aged Care, 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.

Types of palliative care-related prescriptions

Previously, the Palliative care services in Australia report has defined types of palliative care-related medicines by categories based on the Anatomical Therapeutic Chemical (ATC) classification system (see the World Health Organization Collaborating Centre for Drug Statistics methodology for further information on the ATC classification system; WHO 2022).

Since 2022, the Palliative care services in Australia report has used an updated method of reporting types of palliative care-related prescriptions, with the 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.

The 5 medication groups are:

pain relief
gastrointestinal symptoms
neurological symptoms
respiratory symptoms
psychological symptoms.

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 (2017–18 to 2021–22).

Note that the medication types (at the ATC level 2) in editions of this report before 2022 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.

Table 1. Palliative Care Schedule medicines according to medication group

Medication group	ATC level 2	ATC level 3	ATC level 5	Medication name/s
Pain relief	Anti-inflammatory and antirheumatic products	Anti-inflammatory and antirheumatic products, non-steroids	M01AB01	Indometacin
			M01AB05	Diclofenac
			M01AE01	Ibuprofen
			M01AE02	Naproxen
	Analgesics	Opioids	N02AA01	Morphine (excluding PBS items 11760Y and 11761B)
			N02AA03	Hydromorphone
			N02AA05	Oxycodone
			N02AA55	Oxycodone + Naloxone
			N02AB03	Fentanyl
			N02AE01	Buprenorphine
			N02AC	Methadone
		Other analgesics and antipyretics	N02BE01	Paracetamol
Gastrointestinal symptoms	Stomatological preparations	Stomatological preparations	A01AD02	Benzydamine
	Drugs for functional gastrointestinal disorders	Propulsives	A03FA01	Metoclopramide
	Drugs for functional gastrointestinal disorders	Belladonna and derivatives, plain	A03BB01	Hyoscine butylbromide (aka butylscopolamine)*
	Drugs for constipation	Drugs for constipation	A06AB02, A06AG02	Bisacodyl
			A06AC53	Rhamnus frangula + sterculia
			A06AD15	Macrogol - 3350
			A06AD15	Macrogol - 3350 + sodium chloride + bicarbonate + potassium chloride
			A06AG20	Citric acid + lauryl sulfoacetate sodium + sorbitol
			A06AH01	Methylnaltrexone
Neurological symptoms	Antiepileptics	Antiepileptics	N03AE01	Clonazepam
Respiratory symptoms (Chronic breathlessness)	Analgesics	Opioids	N02AA01	Morphine (PBS items 11760Y and 11761B only)**
Psychological symptoms	Psycholeptics	Antipsychotics	N05AD01	Haloperidol*
		Hypnotics and sedatives	N05CD07	Temazepam
		Hypnotics and sedatives	N05CD02	Nitrazepam
		Anxiolytics	N05BA01	Diazepam
		Anxiolytics	N05BA04	Oxazepam

*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.

Coverage and scope of data source

PBS/RPBS data do not capture the following:

Over the counter medicines
Medicines supplied to public hospital inpatients
Private prescriptions (that is, if a medicine is not listed under the PBS Schedule for a specific indication, but it has market authorisation by the Therapeutic Goods Administration for sale).

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.

Relevant changes to the Pharmaceutical Benefits Scheme and Repatriation Pharmaceutical Benefits Scheme over time

Reporting of subsidised and under co-payment prescription data

Until 1 April 2012, PBS and RPBS prescription data supplied to the AIHW by the Department of Health and Aged Care 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 (DoHA 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. Since 2022, the Palliative care services in Australia report combines under co-payment and subsidised data in most tables. An additional table by patient beneficiaries shows the palliative care data by co-payment type in a single table for 2021–22 (Table PBS.3), rather than including this split in every table.

Changes to restriction levels on the Palliative Care Scheme

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.

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 2016). These changes particularly affect medications in this report that come under the ‘pain relief’ and ‘gastrointestinal symptoms’ categories. See the Data sources section for further information.

References

DoHA (Department of Health and Ageing) (2011) Pharmaceutical Benefits Scheme Collection of Under Co-payment Data, Canberra: Department of Health and Ageing, Australian Government, accessed 10 January 2023.

DoH (Department of Health) (2016) Schedule of Pharmaceutical Benefits: Summary of Changes. Effective 1 January 2016, Canberra: Department of Health, Australian Government, accessed 10 January 2023.

Therapeutic Guidelines Limited (2021) Therapeutic Guidelines: Palliative Care, Therapeutic Guidelines Limited, accessed 10 March 2023.

WHO (World Health Organization) (2022) ATC Structure and principles, World Health Organisation, accessed 18 January 2023.

Key concepts Expand

Key concept	Description
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.
Patient co-payment	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 2022 the co-payment was $42.50 (general) and $6.80 (concessional, including repatriation).
Subsidised prescription	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.