Federal Government changes to Opioid Dependence Treatment funding

The recent Federal budget included a commitment of $377.3 million over four years from 2023-24 to reform opioid dependence treatment (ODT) access. These ODT medications are subject to a daily unregulated fee for dispensing and administration and fall outside of the Pharmaceutical Benefits Scheme (PBS) Safety-Net.

From 1 July 2023 people who receive ODT medications will no longer pay a daily fee. This change will benefit consumers as it will reduce the cost of treatment for most people accessing ODT across Australia. This is a very welcome step in reducing inequity and removing barriers to accessing healthcare for a stigmatised and marginalised group of people.

What this means for patients:

• From 1 July 2023, people prescribed PBS-listed medicines for the treatment of opioid dependence (for example methadone, buprenorphine, and Buvidal/depot buprenorphine) will pay a PBS co-payment to access their treatment (for up to 28 days supply per pharmaceutical benefit prescribed) and the amount paid will contribute towards their PBS Safety-Net.
• Concession card holders will pay $7.30 per month and Medicare card holders will pay $30 per month at PBS-approved community pharmacies.
• Additional private dispensing or dosing fees will not be charged by pharmacies for access to these medicines.
• Consistency of access across the nation as any Australian will be paying the same amount for the PBS-listed treatment medicines.

What this means for community pharmacies:

• ODT medicines will be dispensed in the same way as other community access Section 100 HSD Program medicines.
• PBS pharmacies will be able to dispense prescriptions for methadone in a quantity equivalent to 28 days supply (e.g. 140mL per prescription for a 5 mL per day dose), and for buprenorphine in a quantity available in each pack per strength (e.g. one box of Subutex 8mg, 28 per prescription). The dispensed medicine can be held by the pharmacy and supplied to the patient as clinically required, maintaining existing safe supply procedures.
• PBS pharmacies will purchase the medicines and receive reimbursement plus a mark-up, dispensing fee, dangerous drug fee, and a staged-supply fee if applicable.

What this means for GPs and other community doctors:

• ODT medicines will be prescribed in the same way as other community access Section 100 HSD Program medicines.
• Streamlined authority numbers will shortly be released. Extended prescriptions > three months will require telephone authority.
• Transitional approval is expected to enable prescriptions written before 30 June 2023 to be accepted.
• Both State and Federal Government requirements must be met. There is no change to NSW Health authorisation for prescribers or NSW clinical guidelines.

What this means for private clinics, non-PBS pharmacies, public clinics and their patients:

• Discussions are ongoing with private providers around the impacts of these changes on their businesses with a focus on providing continuity of care for patients. More information will be provided once available.
• Public clinics will continue to operate. There will be internal changes to medication supply and funding arrangements but no patient facing changes.

Overall, these changes are welcomed and will make a significant difference to consumers but other barriers to accessing ODT are not directly addressed by PBS listing. While the PBS changes that ‘mainstream’ this program will make it easier for GPs, there are only a small number of GPs who currently prescribe ODT.

Central and Eastern Sydney Primary Health Network (CESPHN) and our partners are committed to supporting increasing the number of available GPs who can prescribe. We are currently consulting with partners and stakeholders around further education and support in this area – if you would like to discuss this with us, please contact us via email at info@cesphn.com.au.

Further resources

• The Department of Health and Aged Care is currently working with the Pharmacy Programs Administrator (PPA) to establish the ODT Community Pharmacy program with Program Rules and User Guides. This is expected to be available on the PPA website from mid-June 2023.

• Further information for prescribers, pharmacies and patients on the PBS listing changes for ODT medicines will be published at www.pbs.gov.au/browse/section100-md when available.

• For queries relating to reforms to ODT access, you can contact the Department of Health and Aged Care via email at ODT@health.gov.au.