Uptake of medicines and prescribing patterns in the palliative care schedule of the Pharmaceutical Benefits Scheme

doi: 10.5694/mja14.00188 Palliative care is a valued aspect of clinical care, especially in general practice.1 On average, a full-time equivalent Australian general practitioner will provide care for three to fi ve people who die an “expected” death each year — that is, people who die from end-stage organ failure, neurodegenerative disease, AIDS or cancer.2 Improving affordable community access to key medicines for palliation is a priority in the National Palliative Care Strategy, which has been endorsed by all Australian governments since 2000.3 Through the Palliative Care Medications Working Group (which takes a whole-of-sector approach that includes government, industry, clinicians and consumers), the fi rst patient-defi ned schedule of the Pharmaceutical Benefi ts Scheme (PBS) was launched in February 2004, with the number of listings steadily growing since that time.4 This list of medicines — the palliative care schedule — was developed within existing legislation and regulations underpinned by the National Medicines Policy, which includes key tenets of access to medicines, quality use of medicines and affordability of medicines.5-7 Priority palliative care medicines had been defi ned in 2000, when a survey of Australian palliative care clinicians was done to seek advice on the pharmacological management of the 22 most frequently encountered symptoms and the way that medicines for these symptoms are used.8 One outcome of the survey was a list of unsubsidised medicines considered to be essential to improve community-based palliative care. The patent had expired on almost all of these medicines, limiting the commercial interests of pharmaceutical companies. Key features that were part of the design of the palliative care schedule in the PBS included: