The government has now delivered on some of the budgetary gifts first announced in May.
On the third day of EOFY, my true love brought to me … Medicare indexation, an opioid dependence therapy overhaul and the down-scheduling of psychedelics.
They also brought new rules for cosmetic surgery, covid antiviral eligibility updates and a registration portal for MyMedicare.
My true love is a little weird.
Indexation
The change with the most immediate implications for general practice is that most of the general medical and diagnostic imaging services listed on Medicare were indexed by 3.6%.
It’s the first of two indexations this year, with the second round likely to occur in November, which would coincide with the tripling of the bulk billing incentive.
The 3.6% rise is noticeably larger than previous indexations, which have sat between 0.9% and 1.6% annually since indexation was restarted in the 2018 financial year.
Of course, over the 12 months to March 2023 the consumer price index rose by 7%.
With the indexation applied, patients can now claim back $41.20 for a Level B consult – an additional $1.45.
Level A rebates have risen to $18.20, Level C consults are now $76.95 and Level D rebates are $113.30.
The promised Level E consults, which will rebate patients for consults that last over an hour, have not yet materialised.
MyMedicare
After releasing an initial fact sheet last week, the Department of Health has officially opened registrations for its voluntary patient enrolment program, MyMedicare.
Interested practices can now use the organisation register in Health Professional Online Services (HPOS) to register for the program and link its eligible providers.
It’s unclear whether practices will have much of an incentive to do so at present, given that patients can’t be registered on the scheme until 1 October.
From November, unregistered practices will no longer have access to longer telehealth rebates, and from July 2024, unregistered practices will no longer be eligible for the soon-to-be introduced GP aged care and frequent hospital user practice incentive payments.
Cosmetic surgery rules
1 July also marked the beginning of what is hoped to be a new era in cosmetic surgery.
Patients who wish to have cosmetic surgery – where a procedure involves cutting beneath the skin – now need a referral from their GP prior to seeing a surgeon.
The Medical Board does not require GPs to have a detailed knowledge of cosmetic procedures, nor does it expect GPs to be seeking patient consent for a procedure they are not personally performing.
Instead, the requirement is intended to add a “layer of protection for patients”, who will be able to “discuss their motivation for cosmetic surgery with their GP, who has the best knowledge of their medical history”.
The responsibility for an assessment of conditions like body dysmorphic disorder sit with the practitioner who performs the cosmetic work.
AHPRA is also planning to crack down on cosmetic doctors who are advertising using patient testimonials, offering incentives to patients or presenting misleading before-and-after pictures.
Opioids
Opioid dependence therapies like oral methadone and long-acting injectable buprenorphine are now covered under the PBS, meaning patients will pay, at most, $30 per month to access the medicines.
Under the altered PBS listing, methadone oral liquid, buprenorphine sublingual tablets, buprenorphine + naloxone sublingual films and long-acting injectable buprenorphine products are now subject to Section 100 Highly Specialised Drug Program arrangements.
The Department of Health has confirmed that GP clinics, state- or territory-approved private clinics and other non-PBS dosing sites can continue to order stock from their regular distributors at no cost until the end of November.
It’s understood that GPs can continue to offer injectable buprenorphine after 30 November so long as the medicine is dispensed by a PBS pharmacy.
Paper scripts written before July 1 remain valid – DoH has advised pharmacists will be able to dispense the medicines under the PBS – but electronic prescriptions will need to be re-issued as a PBS prescription.
Covid oral antivirals available for people aged 50+
Health Minister Mark Butler has rubber-stamped a PBAC recommendation to expand covid antiviral treatment Paxlovid (nirmatrelvir and ritonavir, Pfizer) eligibility to people aged 50 and over who have one risk factor for severe illness.
Minister Butler’s sign-off means that the eligibility changes are now live on the PBS.
It was previously open only to people aged 60 and over with one or more risk factors for severe illness or people aged 50 and over who had two or more risk factors.
The PBAC recommendation was spurred by the fact that Paxlovid stocks already purchased by the government are coming close to expiring.
MDMA and psilocybin down-scheduled
The controversial TGA decision to down-schedule psychedelic drugs MDMA and psilocybin for therapeutic use also came into effect from the beginning of July.
Australia is the first country to have okayed the use of these medicines outside of clinical trials. Both are now recognised as Schedule 8 pharmaceuticals in each state and territory.
Psilocybin, the active ingredient in so-called magic mushrooms, can be prescribed by authorised psychiatrists for treatment-resistant depression, while MDMA can be prescribed for PTSD.
A typical course of treatment with the drugs is expected to cost in the neighbourhood of $15,000 to $35,000.
National Immunisation Program
A new alternative to Infanrix hexa, Vaxelis, has been added to the National Immunisation Program.
While Infanrix hexa has a lyophilised pellet that needs to be reconstituted with the liquid component before administration, Vaxelis is a read-to-use formulation with all components.
Both vaccines treat can be used in the primary vaccination series for children at two, four and six months of age to protect against diptheria, tetanus, pertussis, hepatitis B, poliomyelitis and invasive infections caused by Haemophilus influenzae type b.
The Department of Health stressed that Vaxelis is an alternative NIP-funded vaccine to Infanrix hexa, not a replacement, and that there is no preferred vaccine between the two.
Aged care
The legislated requirement for a registered nurse to be rostered in residential aged care at all times kicked in over the weekend, along with a wage increase for the sector.
A new GP aged care incentive payment, tied to MyMedicare, will begin later this year.
Pharmacy support
Despite ongoing fears that the sector will be negatively affected by the introduction of 60-day dispensing in September, the government claims that it is increasing funding for community pharmacy.
Pharmacy payments have been indexed by 7%, which the Department of Health was quick to point out is almost double the Medicare indexation.
Taken across 12 months, an average pharmacy in a major metropolitan area is expected to receive more than $41,200 in government funding per year.
