JB: Do drug reimbursement schemes go beyond these two degrees?
KG: Another form of financial subsidy is the so-called “Medicare Safety Net”. It allows for an additional reduction in the drugs prices for chronically ill patients and the patients who regularly use many drugs from the reimbursement list. Members of one family (parents plus dependent children) can add up their expenses to achieve the minimum Safety Net threshold within a shorter time. Currently, the minimum Safety Net threshold for the first-degree reimbursement is $ 1542.1 and for the second-degree one it is $ 326.40. Expenses are reset at the end of each year.
JB: It is very interesting. Could you give us more details and come up with some real-life examples?
KG: In practice, this works as follows: Patient A (first degree) takes 9 different reimbursement drugs per month for which he spends 9 x $ 41.30 = $ 371.70 per month. After almost 5 months, patient A will have spent an amount equal to the minimum of the Safety Net, i.e. $ 1542.1, on drugs. From the moment he has spent this amount, the pharmacy system will automatically lower the payment threshold for each additional drug to the second-degree price, which is $ 6.80. Patient A will be paying only $ 6.80 for each reimbursed drug until the end of the year. The same applies to the second degree: once the required minimum amount of money has been spent, the drug is free of charge. The requirement is that the patient does not buy the same drug more often than every 28 days. If the drug is bought more frequently, the sum spent does not count towards the Safety Net. The system works well if the patient uses an online Medicare account. Such an account is always connected to pharmacy IT systems (There is no other option ☺). Patients who do not have an online account must have a paper copy of the Safety Net form, which the pharmacist refers to each time they dispense a drug. This is a more time-consuming process, but possible to do if the patient is disciplined. Payments for drugs work slightly differently for Aboriginal Australians. I won’t talk about it in detail because it applies to a small fraction of the population. In most cases, this group does not pay for drugs, or they pay $ 6.80 like the persons entitled to the second-degree reimbursement.
JB: How do you generally rate this system? Does it work well?
KG: The entire reimbursement system works efficiently thanks to the many rules that apply. The doctor cannot prescribe a reimbursement drug if the patient does not meet the qualifying criteria for the reimbursement of a given drug, e.g. an asthmatic patient must undergo tests confirming that they suffer from the disease. Drugs are prescribed on an algorithmic basis, i.e. after the diagnosis, the doctor starts prescribing cheaper drugs and changes to newer/more expensive drugs only when the patient does not improve after a certain period of time.
JB: Polish pharmacies have undergone revolutionary changes in recent months: we’ve started vaccinating in pharmacies, performing COVID tests… Much more forms of pharmaceutical care are planned for the near future. Is it also practiced in Australian open pharmacies?
KG: Yes, pharmaceutical care works very well here. Most patients seek the advice of a pharmacist before visiting a doctor’s office. It is provided to the patient free of charge, quickly and efficiently. The patient goes to the doctor on the recommendation of the pharmacist. Doctors diagnose medical problems and prescribe drugs, and only generally (mainly due to lack of time) explain what the effects of their application would be. And then, the pharmacists have to explain the details. If the drug is new to the patient, the pharmacist prints out an information leaflet and talks to the patient – usually it’s a 10–15-minute conversation – highlighting the most important information about the drug, giving advice on lifestyle changes (if relevant) and answering questions.