Australian Pharmaceutical Benefits Scheme Expands Subsidies for Multiple Conditions, Reduces Co-Payments

The Australian Pharmaceutical Benefits Scheme (PBS) has expanded its listings to include new and amended subsidies for medications treating conditions such as juvenile arthritis, rare liver disease, multiple sclerosis, chronic kidney disease, and psoriasis. These significant additions aim to reduce treatment costs for eligible patients.

The maximum co-payment for PBS-listed medicines is now set at $25, and $7.70 for concession card holders.

PBS Expansion and Co-Payment Details

The Pharmaceutical Benefits Scheme has broadened its coverage to encompass additional medications, alongside adjustments to patient co-payments. The maximum co-payment for PBS-listed medications is $25, with concession card holders paying $7.70 per script. This represents a reduction from previous co-payment levels, with one source indicating a past maximum of $31.60. The concessional co-payment of $7.70 is reported to remain until 2030.

Health Minister Mark Butler stated that these subsidies are intended to reduce patient expenses.

The PBS operates as a component of the Australian Government’s National Medicines Policy.

Medications for Juvenile Arthritis and Rare Liver Disease

The PBS listing for Adalimumab has been expanded to include juvenile idiopathic arthritis and other pediatric immune-mediated inflammatory diseases (IMIDs), such as Crohn’s disease, ulcerative colitis, and chronic plaque psoriasis. These conditions can cause inflammation, impair growth, and lead to long-term disability. Adalimumab functions by moderating the immune system and reducing inflammation. An estimated 18,500 to 30,100 Australians aged 0-24 live with arthritis. Without the PBS subsidy, a script for Humira would cost approximately $650.

This medication has received its first-time PBS listing for the treatment of progressive familial intrahepatic cholestasis (PFIC). PFIC is a group of rare genetic liver diseases primarily affecting children, characterized by bile acid accumulation in the liver, leading to itching, poor sleep, and progressive liver damage that may necessitate a liver transplant. Bylvay aims to reduce bile acid levels in the gut. PFIC is estimated to affect between one per 50,000 and one per 100,000 live births globally. An unsubsidized script for Bylvay could exceed $200,000.

Medications for Multiple Sclerosis

Ublituximab has also received its first-time PBS listing for relapsing-remitting multiple sclerosis (RRMS). RRMS is an autoimmune disease affecting the central nervous system, potentially leading to symptoms and long-term disability impacting mobility, vision, and independence. Briumvi targets B-cells associated with inflammation in multiple sclerosis. Over 14,000 patients accessed comparable treatments via the PBS in 2024. Without subsidy, a Briumvi script could cost approximately $15,000.

This listing follows the December approval of an 'under-the-skin' injection for ocrelizumab (Ocrevus) for adult patients with RRMS, marking a second consecutive month for an RRMS treatment listing.

Medications for Chronic Kidney Disease and Psoriasis

The PBS listing for Dapagliflozin has been expanded to cover a larger number of Australians with chronic kidney disease. This condition involves a decline in kidney function, potentially leading to complications such as heart disease and kidney failure. The expansion aims to reduce strain on the kidneys and slow disease progression, with an estimated benefit to 65,000 Australians annually. An unsubsidized script for Forxiga would exceed $670.

This medication has been listed for the first time on the PBS for the treatment of chronic stable plaque-type psoriasis vulgaris. Psoriasis is a long-term skin condition characterized by raised, red, scaly patches. Wynzora® works by slowing the overgrowth of skin cells and reducing inflammation. Over 141,000 patients accessed a comparable treatment via the PBS in 2024. Without subsidy, a script might cost $65.

PBS Operational Details

The Pharmaceutical Benefits Scheme, which commenced in 1948, now lists over 900 medicines across more than 5000 different brands. The scheme is managed by the Department of Health, Disability and Ageing and administered by Services Australia. Since July 2022, the Australian Government has approved funding for 399 new and amended listings on the PBS.