Patches should stay on PBS: college

The impact of delisting for concessional patients and those on the Close the Gap scheme will be too great, one expert says.

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The RACGP and five other organisations have written to Health Minister Mark Butler over concerns that nicotine patches may be removed from the PBS next year, constituting a “major threat to public health”.

Next April, nicotine patches are due for a 26% statutory price reduction as they will have been listed on the PBS for over 15 years.

This has prompted leaders from the RACGP, the Lung Foundation, Asthma Australia, Cancer Council Australia, Cancer Council Victoria and the Pharmaceutical Society of Australia to pen a letter raising concerns that this price drop may make the patches ineligible for PBS subsidies as the approved ex-manufacturer price (AEMP) will fall to $26.

The group has called on the health minister to exempt the nicotine patches from the price reduction to keep this mainstay of smoking cessation on the PBS.

Although removal of the patches from the PBS may have a limited effect on the out-of-pocket costs for general patients – the PBS did not reply to requests for confirmation prior to this article’s deadline – concessional patients and those on the Close the Gap scheme would likely incur significant price increases.

Speaking to The Medical Republic, RACGP’s poverty and health group chair Dr Tim Senior said that the most disappointing aspect of this move would be the “disproportional” socioeconomic impact.

He said it would be disadvantaged patients in lower socioeconomic brackets, who are more likely to smoke, who will be most affected by price increases for smoking cessation products.

“Putting any cost impact on smoking cessation therapy is putting barriers in the way of people who need it most,” he said.

In concurrence with Dr Senior, the letter to Mr Butler says it is “critically important” to maintain reduced prices for nicotine replacement therapies for Aboriginal and Torres Strait Islander peoples under the Closing the Gap scheme.

Currently concessional CTG scheme patients pay the capped fee of $7.30 for nicotine patches on the PBS, and general patients pay $30.

Earlier this year, other nicotine replacement therapies – gums and lozenges – were removed from the PBS due to price cuts, Dr Nicole Higgins told The Medical Republic last month.

“[Nicotine replacement therapies] are an important part of our toolbox for addressing smoking cessation, and we need to make sure that they’re going to be accessible to the most vulnerable groups,” she said.

Dr Senior told TMR that programs funding these NRTs outside of the PBS had been highly popular, but without these schemes patient access was limited.

“There’s pretty good evidence that [nicotine replacement] works, with particular impact in people who are pregnant where smoking cessation is really important.”

Dr Senior said removal of nicotine patches from the PBS would likely lead to uptake in other smoking cessation options, like varenicline and bupropion, which can have adverse effects and are not recommended for some patients, such as pregnant women.

“Quite a few people have side effects from [varenicline and bupropion] which reduces our range of options in medication management for smoking cessation.

“Nicotine replacement is actually the safest option for treatment in pregnancy.”

 The letter asks Mr Butler for a price reduction exemption, at his discretion, as smoking remains Australia’s leading cause of early death and disability.

“Appropriately, the Australian government has set ambitious tobacco control targets,” the letter says.

“Achieving these targets depends critically on the ongoing availability of effective, affordable and accessible tobacco smoking cessation medications.”

The loss of NRTs on the PBS would be a “major threat to public health” said the group, and to “planned reforms to tobacco control legislation, the national tobacco strategy and the lung cancer screening program”.

It would also aid those seeking wider consumer availability of e-cigarettes, they added.

“There’ll be a big push on from the vaping advocates saying that nicotine replacement in vaping is the solution to this,” Dr Senior told TMR.

“There’s not strong evidence for that. But there will be a big push for that, including from the tobacco companies.”

Although relatively small price increase may have limited effects of those of us on decent pay checks, said Dr Senior, “for the people who most need it, it prices them out of treatment”.

“For smoking, that has, potentially, a big impact.”