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Pharmaceutical Benefits Scheme (PBS) Restrictions Wording Tool – Background and Progress

Faster PBS updates. Positioned for future change. Increased transparency. Streamlined processes. Pharmaceutical Benefits Scheme (PBS) Restrictions Wording Tool – Background and Progress. February 2009. Effective Date 1 st Month. Effective Date 1 st Month.

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Pharmaceutical Benefits Scheme (PBS) Restrictions Wording Tool – Background and Progress

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  1. Faster PBS updates Positioned for future change Increased transparency Streamlined processes Pharmaceutical Benefits Scheme (PBS) Restrictions Wording Tool – Background and Progress February 2009

  2. Effective Date 1st Month Effective Date 1st Month Effective Date 1st Month Effective Date 1st Month Effective Date 1st Month Publication Tier 1 Fast track timing issues What are our targets? What is the undertaking to be met? Industry expect Tier 1 drugs (on the fast track process) can be listed 6-8 weeks after PBAC. • For 2007, Tier 1 drugs should be updated on the PBS by the second monthly effective date following PBAC. • On implementation of PharmCIS, Tier 1 drugs should be updated 3 weeks after PBAC. Can this undertaking be met? A ‘minimal change’ approach to business as usual in converting to a Monthly Listing from December will result in Tier 1 drugs being listed about 13 weeks after PBAC. So more significant changes were required. What are the ‘minimal change to business as usual’ timings for the monthly listing cycle? March July November April August December 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 1 2 3 4 5 6……… Week 7 Week 8 Week 9 Week 0 Week 1 Week 2 Week 3 Week 4 Week 5 Week 6 PBAC Secretariat Listing Notification X Wed – Fri 1st Week of month Cutoff not met – Tier 1 listed in about 13 weeks. How can the 8 week undertaking be met? Effective Date 1st Month March July November April August December Wk 12 Week 14 Week 15 Week 16 Week 1 Week 2 Week 6 Week 3 Week 4 Week 5 Week 7 Week 8 Week 17 Listing PBAC Secretariat DUSC ESC RWG Notification Publication Finalisation Data removal Pre-listing P Met the cutoff – Tier 1 listed in about 8 weeks. Pre-entry of Tier 1 drug data

  3. Effective Date 1st Month Effective Date 1st Month Effective Date 1st Month Effective Date 1st Month PBS Monthly update timing issues What are our targets? • Tier 1 drugs should be updated on the PBS by the first monthly effective date following PBAC. • All changes to PBS, once finalised should be ‘published’ in 3-6 weeks. Tier 1: How can we improve the process? Effective Date 1st Month March July November April August December Wk 12 Week 14 Week 15 Week 16 Week 1 Week 2 Week 6 Week 3 Week 4 Week 5 Week 7 Week 8 Week 17 PBAC Publication Secretariat DUSC ESC RWG Notification P Met the cutoff – changes listed in about 4 weeks. Issues • Contracting the process to 4 weeks requires improvements in the efficiency of all aspects of the process, including reducing the notification period to about 2 weeks. • One month only feasible if there is high quality electronic data transfer (XML) Other monthly processes: How can we improve the process? Effective Date 1st Month Wk 12 Week 14 Week 15 Week 16 Week 1 Week 2 Week 6 Week 3 Week 4 Week 5 Week 7 Week 8 Week 17 Publication Notification Issues Issues • Changes happening any month could include: • Minor submissions • Deletions • Change of Details • RPBS • Tier 3 • Tier 2 • New Brands? • Section 100 drugs

  4. Medicare and Software Vendors told us that Restrictions/Authorities are the key to reducing the time between the listing of drugs on the PBS and their availability through Doctors’ prescribing software. Proposed solution Develop a syntax so that restrictions/authorities are produced as an xml update for prescribing software in much the same way virus definitions are made available to virus-detection software. This meant developing a tool for those writing restrictions to be able to produce them in the required syntax. Where are we now? Syntax has been drafted. Data model proposed Prototype tool has been developed How can the Notification Period be just 2 weeks?

  5. Simplified entry of restrictions/authorities as a result of using the tool Data entry possible earlier in the process of defining a listing – maybe even by industry Provides consistency – easier to manage (flow-ons and expertise) Believe that restrictions will be easier to understand and use Reduces (?eliminates) interpretation of restrictions rules by software vendors – increases consistency in application of rules Process Benefits From RWT

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