Masters Slide Deck Class Two

Overview of the Australian Healthcare System

• Overview of how the systems function and pharmacists' roles in it.

Medicare

• Definition: A universal health insurance scheme.

• Coverage: Rebates services/procedures by GPs and other medical practitioners.

• Public Treatment: Free treatment for public patients in public hospitals.

• Medication Access: Ensures medication access under the Pharmaceutical Benefits Scheme (PBS).

Eligibility for Medicare

• Eligible Groups:

  • Australian and New Zealand citizens.

  • Permanent residents in Australia.

  • Individuals from countries with reciprocal agreements (Belgium, Finland, Italy, Malta, Netherlands, Norway, Republic of Ireland, Slovenia, Sweden, UK).

Funding

• Source: Funded by the Australian Government through a taxation levy.

• Proof of Eligibility: Medicare card required to access services, vital for pharmacists.

Repatriation Benefits

• Who Qualifies: Individuals who served in armed forces.

• Eligibility Colors: Different levels indicated by card color; some may not have a Medicare card.

• Medications Access: Access to a broader range of subsidised medications.

Social Security Cards

• Support: Provides social security benefits for citizens to assist with living costs (old age pension, disability, unemployment, carer).

• Medication Subsidy: Reduces medication prices for patients; necessary for appropriate dispensing in community pharmacies.

Pharmaceutical Benefits Scheme (PBS)

• Purpose: Government subsidizes medication prices for those with a Medicare card.

• Pricing System: Prices set through a combination of fees and markups negotiated between the pharmacy sector and the federal government.

Medication Pricing Under PBS

• Threshold Payments:

  • If above the threshold, patients pay set amount; government covers the rest.

  • If below, pharmacies can set prices (within guidelines).

• Subsidization: Not all medications are subsidised.

• Annual Changes: Threshold amounts typically adjusted yearly.

PBS Administration

• Managed by the federal government; consistent rules apply across Australia.

State Regulations

• Public Hospitals: Administered by states, each with unique legal regulations affecting pharmacy practices.

• Federal vs State: Federal determines payment eligibility; states determine legal practices.

State Regulations Examples

• Medicines, Poisons, Therapeutic Goods Regulations: Unique to each state/territory (e.g., ACT version).

• Legality Considerations: Prescriptions and labelling requirements are state-specific.

Poisons Standard

• Classification: Records decisions on classifying medicines/chemicals into schedules for regulation.

• Public Health Regulation: Ensures availability is controlled to protect public health.

• State Variability: Handling of schedules differs across states.

Drug Schedules in Pharmacy

• Schedule 2: Pharmacy medicine, sold only in pharmacies with pharmacist availability.

• Schedule 3: Pharmacist Only, requiring pharmacist involvement and restricted public access.

• Schedule 4: Prescription Only, dispensed only on valid prescriptions.

• Schedule 8: Controlled Drugs, high risk of abuse/misuse, securely stored.

• Schedule 9: Prohibited substances.

Drug Scheduling Factors

• Schedule determination considers not only the medication but also factors like pack size or combination ingredients.