Access to medicines for palliative care on the PBS

Page last updated: 16 September 2016

Many people who want to receive palliative care at home are unable to afford the medicines they need.

The Australian Government is committed to providing affordable access to medicines used for palliative care by listing medicines specifically for palliative care use, and through this supporting the National Palliative Care Program.  Items recommended by the Pharmaceutical Benefits Advisory Committee (PBAC) for subsidy for people receiving palliative care are included in a separate section of the PBS Schedule.

It is important to note that the Palliative Care Schedule is intended to complement the general Schedule, which also contains many medicines suitable for use in palliative care.  Where medicines are included in both the general Schedule and the Palliative Care Schedule, the benefit of the Palliative Care Schedule is that items are often listed with larger quantities suitable for palliative care use. This can reduce patient co-payment costs.  Medicines listed in the Palliative Care Schedule also often have an increased number of repeats. This can reduce the number of doctor’s visits required to obtain prescriptions for continuing therapy. For further information please visit How to use the Palliative Care Schedule of the PBS.

How does a medicine become subsidised via the PBS?

Prior to listing on the PBS a medicine must be approved by the Therapeutic Goods Administration (TGA) and registered on the Australian Register of Therapeutic Goods (ARTG). This involves the TGA reviewing the evidence to demonstrate that the medicine is safe and effective for the proposed use (indications).

Pharmaceutical companies may make a submission for PBS listing for any medicine which is TGA-registered or for which a registration dossier has been lodged with the TGA. For a medicine to be listed on the PBS it must be recommended by the PBAC.  When recommending a medicine for listing on the PBS, the PBAC takes into account the medical conditions for which the medicine was registered for use in Australia, its clinical effectiveness, safety and cost – effectiveness (value for money) compared with other treatments. For further details on how to list on the PBS refer to the PBS website.

The Pharmaceutical Benefits Advisory Committee (PBAC) is also responsible for making recommendations to the Minister for Health regarding medicines for specific palliative care listing resulting in inclusion in the Palliative Care Schedule.

How to use the Palliative Care Schedule of the PBS

For the purpose of prescribing medicines listed in the Palliative Care Schedule, a patient receiving palliative care is defined as: A patient with an active, progressive, far-advanced disease for whom the prognosis is limited and the focus of care is the quality of life. This means that these medicines can be prescribed for any person with a life-limiting condition, regardless of the condition or the reason for palliative care.

The Pharmaceutical Benefits Advisory Committee (PBAC) is responsible for making recommendations to the Minister for Health regarding medicines for specific palliative care listing, resulting in inclusion in the Palliative Care Schedule.

Palliative Care listings may provide for the prescribing of larger maximum quantities of the medicine and more repeats than listings for the same medicine in the general schedule.  The quantities and repeats are intended to be appropriate for palliative care use.

Medical practitioners may prescribe any palliative care item and other PBS prescribers (eg. nurse practitioners) may prescribe items as indicated in the Schedule.

Most palliative care listings are available as “Authority Required” (Streamlined) or Restricted Benefits, intended to provide up to four months therapy in total (as an original prescription with repeats). Subsequent continuing therapy can be prescribed on consecutive occasions under these listings if required.

Prior approval from the Department of Human Services is not required to prescribe an "Authority Required" (Streamlined) item where the quantity and number of repeats are not more than stated in the listing.  “Authority Required” (Streamlined) items are written on an authority prescription form and must include the specified four - digit streamlined authority code.

Prior approval from the Department of Human Services or the Department of Veterans’ Affairs (DVA) is required for each prescription to prescribe quantities and/or repeats above the number in the listing. (Refer to Prescribing Medicines — Information for PBS prescribers and Supplying Medicines — What Pharmacists Need to Know, for more information on authority prescriptions.) For prior DVA approval to prescribe certain palliative care medicines not included in the PBS Palliative Care Schedule please contact Veterans' Affairs Pharmaceutical Approvals Centre.

The Palliative Care Clinical Studies Collaborative (PaCCSC)

The Palliative Care Clinical Studies Collaborative (PaCCSC) is a group of palliative care units across Australia. The group was established to conduct clinical studies and gather the evidence required to support the registration of medicines on the Australian Register of Therapeutic Goods for palliative care use, and subsequently support further PBS listings. This work may help to provide affordable access to medicines currently available for palliative care use in public hospitals.

Pharmaceutical companies may also make a submission for PBS listing for any medicine which is TGA-registered or for which a registration dossier has been lodged with the TGA for a palliative care use.

For further information refer to the National Palliative Care Projects, the PBS Palliative Care Schedule, and the Schedule of Pharmaceutical Benefits. The Schedule is updated monthly to include new listings and latest changes.