The 60 day script for medication treating chronic stable medical conditions was first recommended in August 2018 - it finally arrives in September 2023

 

RACGP: 60-day dispensing a win for Aussie patients

Royal Australian College of GPs

The Royal Australian College of General Practitioners (RACGP) has warmly welcomed the federal Government’s decision to put patients first and make medicines cheaper and easier to access.

It comes following the Minister for Health and Aged Care Mark Butler’s announcement today doubling the amount of medicine a pharmacy can dispense to a patient to up to 60 days’ worth for more than 320 medicines on the Pharmaceutical Benefits Scheme. This effectively halves the dispensing fees for these medicines.

Currently, patients are limited to a 28- or 30-day supply, forcing them to take more trips to the pharmacy for medications for stable conditions. The changes, which will come into effect on 1 September, will save patients up to $180 a year on medications for chronic conditions including heart disease and hypertension.

RACGP President Dr Nicole Higgins said it was a momentous day.

“This is a win for patients,” she said.

“Cost of living pressures are placing tremendous strain on households across Australia, so there has never been a more important time to save patients money and time. Patients with a range of chronic conditions including heart disease will be able to save up to $180 a year and that will make a huge difference for so many households.

“This announcement shows the tide is finally turning. In 2018, the Pharmacy Benefits Advisory Committee recommended increasing the maximum dispensed quantities of common medications from one to two months’ supply. This change has been recommended because it is in the best interests of patients, and I am pleased that the Government has heeded the expert advice.”

Dr Higgins urged the nation’s leaders to remain steadfast.

“Beware of scare campaigns,” she said.

“A recent Westpac report found that pharmacies are reaping record profits, with the total consumer spending in pharmacies rising from $92.5 million in July 2019 to more than $123 million in January this year. Also, despite what you hear from the Pharmacy Guild, there is no evidence of a shortage of the medications that are included in today’s announcement. Some pharmacy owners may be concerned that they will lose retail sales; however, at the end of the day cheaper access to lifesaving medications must come before retail sales, it’s as simple as that.”

The RACGP President said that the was plenty more to be done.

“My aim is for today’s announcement to be just the beginning,” she said.

“Let’s go even further and extend the length of prescriptions for patients with stable chronic conditions. The RACGP also supports further investigation of the benefits to patients in changing the $1 discount rule. It effectively stops pharmacies from discounting medicines that cost more than the current co-payment of $30 by more than $1. When you consider that in New Zealand the patient contribution is as little as $5 for most items, you have to ask whether we can do better here.

“I’m also focussed on reforming the Pharmaceutical Benefits Scheme prescribing system to reduce administration time and free up GPs to do what they do best – care for patients. Right now, the system is too cumbersome and time-consuming. If it was streamlined, GPs would be able to spend more time with patients rather than admin work. As a GP myself in Mackay, that sounds like a winning combination to me.

“It’s also vital that the Government overhauls Australia’s anti-competitive pharmacy ownership and location laws, which inflate costs for patients. The rules appear to be focussed on protecting pharmacy owners rather than increasing patient access to cheaper medicines.

“Today is a great day for Australian patients. The tide is turning, and patient well-being is front and centre – right where it should be. Mark my words, this is just the beginning.”

A recent poll of more than 1,000 GPs who answered the question: “Do you think your patients would benefit from doubling dispensing times to 60 days?” found a staggering 85% said “yes”.

~ ENDS

List of medications possibly being considered for inclusion in 60 day script scheme can be found at:

https://m.pbs.gov.au/industry/listing/elements/pbac-meetings/pbac-outcomes/2022-12/Increased-Dispensing-Quantities-List-of-Medicines.pdf

 

BACKGROUND

AUGUST 2018 PBAC OUTCOMES – OTHER MATTERS, excerpt:

The PBAC considered a list of PBS medicines taken from the Pharmaceutical Benefits Schedule that are indicated for the treatment of chronic conditions. Based on an assessment of clinical safety and ongoing cost-effectiveness, the PBAC recommended that 143 medicines (348 PBS items) were acceptable for listing with increased maximum dispensed quantities (approximately 60 days or two months’ supply per dispensing). The list of medicines accepted by the PBAC as suitable for additional PBS items with increased dispensing quantities (Proposal 2) is available on the PBS website.

Long COVID aka post-acute sequelae of COVID-19 (PASC) in 2023: no you are not imagining it nor being a malingerer. However research is in its infancy with regard to your often debilitating illness

 

First the good news. On 24 April 2023 the Minister For Health & Labor MP for Port Adelaide Mark Butler announced that The Australian Government will provide a further $50 million from the Medical Research Future Fund (MRFF) for research into post-acute sequelae of COVID-19 (PASC) – commonly known as Long COVID.

Bringing the Long COVID research funding pool to a total of $66.6 million and proving that parliamentary committee's can sometimes galvanise government.

The following is a slightly more mixed message, as at this stage prevention of Long COVID seems to rely on the implementation of public health measures the states and territories have long since abandoned in practice.

April 2023
CANBERRA

The 213-page report to the Australian Parliament by the House of Representatives Committee on Health, Aged Care and Sport can be read and downloaded at:

https://parlinfo.aph.gov.au/parlInfo/download/committees/reportrep/RB000006/toc_pdf/SickandtiredCastingalongshadow.pdf

The Committee accepts the World Health Organisation (WHO) definition of Long COVID as being the continuation or development of new symptoms 3 months after the initial SARS-CoV-2 infection, with these symptoms lasting for at least 2 months with no other explanation. Debilitating symptoms can be wide ranging with over 200 being recorded by WHO.

It further accepts that the number of people in Australia who were diagnosed with COVID-19 and were at risk of or possibly went on to develop Long COVID could be anywhere between 228,039 to 2,280,399 individuals. The difficulty in tying down a more definitive figure when it comes to the number of Long COVID suffers is apparently hampered by the paucity of data which has been collected to date.

The report goes on to inform government that:

At this stage it does seem that specific treatments require more evidence of benefit before being specifically recommended, but this will become clearer over time. Certainly, most of the care needs to be provided by the primary care system, such as by GPs, nurses, and allied health professionals.

We will need to help schools, universities, and workplaces adapt to allow the gradual return of people with long COVID. We will also need to train health professionals in how to diagnose and manage long COVID patients.

Mental health issues are clearly an area of concern too, particularly as many suffering from long COVID are aged between 20 and 50 years old and have many concerns, such as family and/or work responsibilities, which place additional stresses on them.....

It is also of concern that women seem more likely to be affected by long COVID than men.

The Committee is also of the view that when it comes to infectious disease and its aftermath:

the development of a national Centre for Disease Control (CDC) within the Department of Health and Aged Care would be the most appropriate mechanism for data collection and linkage with the states and territories.

Likewise, there is much that we do not understand about the virus, such as the fact that it is likely changing from being an acute pandemic virus to now an endemic form.

Research will be very important in helping us understand the best ways and means of managing its ongoing effects, particularly including long COVID. Research should include individuals from Aboriginal and Torres Strait Islander communities, culturally and linguistically diverse communities and other high-risk groups including those who are immunosuppressed.

A research program should be established to nationally coordinate and fund research into long COVID and COVID-19 generally. This could be led by the Department of Health and Aged Care — ideally the CDC — and should be the for the longer term.

Clearly, there has been a number of issues raised about reducing transmission of COVID19, such as improving air quality to reduce aerosol spread and this also has reference to broader health outcomes and requires investigation. 

In addressing the prevention of Long COVID the report states quite clearly:

The committee received evidence that emphasised that the best way to prevent long COVID is to prevent an initial COVID-19 infection.

For example, Professor Margaret Hellard, Director of Programs at the Burnet Institute, argued that while we don’t have a full understanding of long COVID, the most effective way to avoid it is to ‘try and stop COVID and reduce the number of COVID infections.

This position is supported by the National Clinical Evidence Taskforce on COVID-19 (NCET), which recommended the Australian Government clearly communicate to the public and to health care providers ‘that prevention of COVID-19 is the most-effective method of preventing long term health issues’ resulting from the virus.

However, this is difficult to achieve without access to other preventative methods given the highly infectious nature of current Omicron variants circulating in the community.

The NCET summarised:

With the shift away from mandated mask use and regular reporting of COVID-19 cases, and the recent removal of the requirement for isolation following confirmed infection, people may have the highly inaccurate impression that COVID-19 is “over”. There is a lack of messaging that potential health risks related to COVID19 continue to be relevant and that vaccines, mask use in crowded indoor spaces, testing and isolation are still a valuable way to decrease the transmission of SARS-CoV-2, and mitigate the impact of long COVID.

The importance of mask wearing, physical distancing, hygiene and taking other health precautions when visiting high-risk settings cannot be underestimated.

However, the enforcement of these health measures is largely at state and territory government discretion, and to varying extents, now a matter of individual responsibility.

As for the Committee’s view on COVID-19 vaccination:

Booster doses of the COVID-19 vaccine are important to prevent waning immunity against the rapidly mutating COVID-19 virus.

On 8 February 2023 the Hon Mark Butler MP, Minister for Health and Aged Care, announced that from 20 February 2023 all adults who have not had a COVID-19 booster or a confirmed case in the past six months are eligible for a COVID-19 booster, irrespective of how many doses that person has received. Additional boosters for people under the age of 18 have not yet been announced, except where children aged 5 to 17 have health conditions that would put them at risk of severe illness.

Although COVID-19 vaccines are widely available and accessible, data suggests that many people are not electing to receive additional doses for which they are eligible. Professor Crabb AC suggested that this may be due to people becoming less aware of the risks associated with COVID-19 infections as the pandemic continues and commented on a general lack of motivation experienced by many people who received their first two doses but ‘don’t see the benefit’ in receiving booster doses......

The Committee made 9 recommendations to government which can be found on xxi & xxiv of the report.

Disappointing news for those on Centrelink unemployment benefits

 

The Interim Economic Inclusion Advisory Committee was created by the Albanese Government in December 2022.

Membership of this committee is intended to be up to 14 members, including a Chair, and include a mix of social security academic experts, representatives from key relevant advocacy organisations, unions, business peak bodies, the philanthropic sector and economists.

CHART: Interim Economic Inclusion Advisory Committee, 2023–24 Report to the Australian Government, p.90

Its purpose is to provide non-binding written advice on economic inclusion, including policy settings, systems and structures, and the adequacy, effectiveness and sustainability of income support payments ahead of every Budget.

The Interim Economic Inclusion Advisory Committee’s April 2023 InterimEconomic Inclusion Advisory Committee, 2023–24 Report to theAustralian Government made 37 recommendations in this 97 page document which covers aspects of: adequacy of working age payments; full employment objective; addressing disadvantage in places where it is concentrated; removing barriers to economic inclusion – families with children; and, advice on legislated measures on economic inclusion and poverty reduction.

The first three recommendations are:

Recommendation 1

The Government commit to a substantial increase in the base rates of JobSeeker Payment and related working age payments as a first priority.

Recommendation 2

The Government commit to increase Commonwealth Rent Assistance and reform its indexation to better reflect rent paid.

Recommendation 3

The Government commit to a timeframe for the full increases to be implemented, if increases are to be staged.

In the joint media release of 18 April 2023, Australian Treasurer & Labor MP for Rankin Jim Chalmers and Minister for Social Services & Labor MP for Kingston Amanda Risworth signalled an intention not to support the first recommendation in the 2023-24 financial year and did not give hope that all three of the aforementioned recommendations will become future priorities anytime soon.

BACKGROUND

Interim Economic Inclusion Advisory Committee, 2023–24 Report to the Australian Government, excerpt, pp3-4:

Introduction

Adequacy of income support

The Committee focused first on the adequacy of income support for more than one million people in Australia who receive working age payments like JobSeeker or Youth Allowance. All indicators available to the Committee show current rates of these payments are seriously inadequate, whether measured relative to the National Minimum Wage, in comparison with pensions, or against a range of income poverty measures. People on these payments face the highest levels of financial stress in Australia. Committee members heard from people who live on income support having to choose between paying for their medicine or electricity bills.

The Committee recommends the Government, as a first priority, commit to a substantial increase in the base rates of the JobSeeker Payment and related working age payments. Income support should better value unpaid caring work and support those who cannot be in full-time paid employment, including due to illness, disability or partial capacity to participate.

The Committee also found the current rate of Commonwealth Rent Assistance (CRA) to be inadequate. At a time of rapidly rising rents, the 1.3 million Australian households receiving CRA are at greater risk of financial stress and poverty. The

Committee recommends the Government commit to increase CRA and reform its indexation to better reflect rent paid.....

In 2023 is Clarence Valley Council preparing to walk away from a drowning town?

Aerial view of a section of Yamba township precinct during flooding in 2022. IMAGE: Clarence Valley Independent

On Tuesday, 18 March 2023 Clarence Valley Council held its Ordinary Monthly Meeting.

Officially present at that meeting according to the Minutes were:

Cr Greg Clancy [Deputy Mayor], Cr Bill Day, Cr Peter Johnstone, Cr Debrah Novak, Cr Steve Pickering, Cr Jeff Smith, Cr Ian Tiley [Mayor], Cr Karen Toms and Cr Allison Whaites, General Manager (Laura Black), Director – Corporate & Community (Alex Moar), Director – Environment & Planning (Adam Cameron), Director – Works & Civil (Jamie Fleeting) and Minutes Secretary (Lee Boon).

The fourth item of business for Council In The Chamber that day was the following Notice of Motion:

Item 06.23.004 Rezoning Lands on West Yamba Floodplain

Note: Crs Tiley and Johnstone left the Chamber ahead of this motion at 2:08pm, having asserted a non-pecuniary conflict of interest existed in relation to Item 06.23.004. Both noting sitting members on Northern Joint Regional Planning Panel. Under s6.1 of the Code of Meeting Practice, the Deputy Chair became the chair in the Mayor’s absence.

MOTION

Clancy/Smith

That Council:

1. note the legal advice tabled at the February Ordinary Council Meeting that compensation would not be

payable in the event that the Department of Planning and Environment, on the recommendation of

Council, was to approve a rezoning of lands in the West Yamba Urban Release Area (WYURA) from

residential R1 to C2 or a mix of C2 and RU2 depending on the results of the planning study;

2. prepare a planning proposal for submission to the Department of Planning and Environment requesting

that the vacant land, which do not have development approvals for subdivision, in the West Yamba

Urban Release Area (WYURA) be rezoned from Residential (R1) to Conservation (C2) zoning or a mix

of Conservation (C2) and Rural (RU2) based on the impacts of further development on the environment

and the risk to human life and property from future flooding.

Voting recorded as follows

For: Clancy, Smith

Against: Day, Novak, Pickering, Toms, Whaites

The Motion was put and declared LOST

[my yellow highlighting]

To say that the writer of this post is disappointed beyond measure at this outcome is an understatement.

Those names listed as voting down the re-zoning motion, Bill Day, Debrah Novak, Steve Pickering, Karen Toms and Allison Waites, should be noted for future reference by Yamba residents & ratepayers when - as landfill proceeds apace -  the next inevitable major Lower Clarence River flood arrives.

An alternate Motion in Item 06.23.004 was put up by Cr. Day & seconded by Cr. Smith and lost. That particular risible motion all but issued an invitation to the NSW Nationals to turn any rezoning of the West Yamba Urban Release Area into both a regional and state brawl along partisan political lines in which property developers would have eagerly participated. It was voted down by Crs. Clancy, Novak, Toms, Whaites.

BACKGROUND

SUMMARY

Approved development of the Yamba floodplain under the provisions of the West Yamba Urban Release Area (WYURA) planning approval has resulted in large amounts of fill being transported to the site, particularly along Gardeners Road, Yamba Road and Carrs Drive. The constant truck movements (1 every 10 minutes), has caused great consternation among a number of Yamba residents. The large amount of fill would appear to be exacerbating localized flooding around the Carrs Drive roundabout and the area surrounding it. There is also concern that the large amount of fill is affecting, and will increasing affect, the drainage of the area, adversely affecting low lying residences and the environment.

PROPOSED MOTION

That Council:

1. note the legal advice tabled at the February Ordinary Council Meeting that compensation would not be payable in the event that the Department of Planning and Environment, on the recommendation of Council, was to approve a rezoning of lands in the West Yamba Urban Release Area (WYURA) from residential R1 to C2 or a mix of C2 and RU2 depending on the results of the planning study;

2. prepare a planning proposal for submission to the Department of Planning and Environment requesting that the vacant land, which do not have development approvals for subdivision, in the West Yamba Urban Release Area (WYURA) be rezoned from Residential (R1) to Conservation (C2) zoning or a mix of Conservation (C2) and Rural (RU2) based on the impacts of further development on the environment and the risk to human life and property from future flooding.

The eighth item of business at that 18 April ordinary council meeting was a development application for a 6 lot subdivision of an existing parcel of land in West Yamba Urban Release Area, lodged on behalf of a commercial fisher-cum-property developer. 

It was refused as per COUNCIL RESOLUTION - 07.23.050

Clancy/Johnstone

That council refuse Development Application SUB2021/0045 for the following reasons covered by

Section 4.15 of the Environmental, Planning and Assessment Act 1979:

a) The land being a wetland (Swamp Forest of Swamp Oak) making it unsuitable for the proposed development;

b) The nine submissions raised major concerns about the potential for flooding, impacts of stormwater runoff and clearing of natural vegetation.

c) The likely impacts of the development on the natural environment;

d) Impact on areas of C2 zoning for some infrastructure.

Voting recorded as follows

For: Clancy, Day, Johnstone, Pickering, Smith, Tiley

Against: Novak, Toms, Whaites

DISCLAIMER: The author of this post is a Yamba resident living alone in a single storey dwelling in a street adjoining a 20 year-old 6.65ha landfill comprising est. 90,000 cubic metres of river dredge & soil. The street is regularly cut off by riverine floodwater, or a combination of floodwater and storm water, preventing access to the town's nominal evacuation centre. The author has no independent means of leaving the town if residents are advised to do so ahead of a large flood front. In 2022 a small number of houses within this short street experienced flooding.

It doesn't come as a surprise that the federal electorate of Page sees a low return from Morrison & Frydenberg's legislated Stage 3 tax cuts

 

Page is a large electorate covering an area from Sapphire Beach in the south to Nimbin in the north on the coastal side, and from Nymboida in the south to the Queensland border on the inland side. The main towns include Casino, Dunoon, Evans Head, Grafton, Iluka, Kyogle, Lismore, Nimbin, Sapphire Beach and Wooli. [Australian Electoral Commission, 2023]

It is one of only two federal electorates found in the Northern River region of north-east New South Wales.

That section of Page electorate that contains Kyogle local government area (LGA) has a SEIFA Index relative disadvantage score of 910 - most disadvantaged part of the electorate. The section that takes in Richmond LGA has a SEIFA Index score of 902, Clarence Valley section a SEIFA Index score of 926 and Lismore LGA section a SEIFA Index score of 954 - the least disadvantaged score in found in the electorate.

Page electorate receives only $57 million in Stage 3 tax cuts in 2024-25, compared with the metropolitan North Sydney electorate whose residents draw in a total of $331 million in that same financial year and the largest total listed in the The Australian Institute April 2023 discussion paper.

If the discussion paper's projections hold true then around half of that $54 million in tax cuts will be received by less than 7,000 people currently living and working in the Page electorate.

 

The federal electorate of Richmond having a SEIFA Index disadvantage score ranging from 973 to 1,003 did not rate a mention in the discussion paper, so at this point in time we are all left to wonder what portion of the Stage 3 tax cuts come to the people of Tweed, Ballina and Byron LGAs.

According to Regional Development Australia, in 2022 the median weekly income for the est.124,5742 people who live & work in NSW Northern Rivers region was between $800 to $999. Therefore half of those in this regional workforce had weekly incomes between $0 and $799 dollars.

A total of 55 electorates (around 36% of all electorates) will receive a higher-than-average benefit from the Stage 3 tax cuts. Only four of these are Provincial or Rural seats and, importantly, each has characteristics that makes it atypical. Specifically, each of these seats either enjoys significant mining industry employment, which pushes up average earnings, or contains a large number of people commuting to capital cities…..

 “Many lower-income electorates and individuals will get comparatively little from this quarter of a trillion-dollar cost to the budget and those electorates are more likely to be rural and regional.

“People living in National Party seats and in Tasmanian electorates are some of the biggest losers from Stage 3 when compared to their city counterparts.

“At the other end, high income earners are more likely to be clustered in the inner metro areas of our largest capital cities which is why inner metro electorates get the largest benefit from Stage 3.

“The Stage 3 tax cuts will cost more than a quarter of a trillion dollars to the budget, which will only put pressure on funding essential health, education and community programs outside major cities.  [The Australia Institute, Discussion Paper, "Divided nation: The Stage 3 tax cuts broken down by city and country electorates", April 2023]

At the level of the individual; Around half the Stage 3 tax cuts go to those earning over $180,000, with the total plan costing more than a quarter of a trillion dollars ($254b). Those on less than $45,000 per year will get nothing from Stage 3. [The Australia Institute, media release, 19 April 2023] 

According to The Guardian columnist and policy director at the Centre for Future Work, Greg Jericho, median-income earners pay up to $1,500 more in tax in 2022-23 than they did in 2021-22, while around 75% of all taxpayers will pay more tax in 2025 compared with what they did in 2022.

GRAPH: The Guardian, 20 April 2023

This should come as no surprise. However, because the temporary financial 'bridge' created by the low-middle income tax offset (LMITO) was in effect extended twice and increased once, in an effort to sow the seed of another Morrison presidential-style election victory, the collapse of that bridge under its own unsustainable weight was inevitable. A fact perhaps not at the forefront of inequalities being debated during the April-May 2022 election campaign.

Like many of Scott Morrison's policy manoeuvres, the downside was not timed to present itself until post-May 2022. 

Now there is time to reflect on the fact that only those earning over $100,000 per year will see a noticeable change in take home pay under the 'flattened' personal marginal tax rate 

system. 

When it comes to income earners in the 25th ($40k pa) to 50th ($65k pa) percentile ranges they are just planned collateral damage, having got little enough from previous stages of the Morrison-Frydenberg long-term strategy to have those in the highest wealth percentile inherit Australia.

Marginal Tax Rate for 2024-05 and financial years thereafter.

https://atotaxrates.info/individual-tax-rates-resident/ato-tax-rates-2025

Note:

• The tax exempt earned income range of 0 to $18,200 has not changed since 1 July 2012. Nor has the marginal personal tax rate for those earning between $18,201 to $35,000 changed since 1 July 2012 when it was increased by 4 cents to 19 cents for every dollar over $18,000 and, both remain unchanged in the new 2024-05 tax schedule.

• From 1 July 2020 the marginal personal tax rate for individuals then earning between $37,001 to $45,000 fell to 19 cents in every dollar earned over $18,200 and remains unchanged in the new 2024-05 tax schedule.

• For those with a current taxable income of between $45,001 to $120,000 their marginal personal tax rate falls by 2.5 cents to 30 cents in the dollar earned over $45,000 as they enter a different bracket in the new 2024-05 tax schedule.

• While wage earners with a taxable income between $120,001 to $180,000 see their marginal personal tax rate drop by 7 cents to 30 cents in every dollar earned over $120,000 and, those with a taxable income between $180,001 to $200,000 will see their tax rate drop 15 cents to 30 cents in every dollar earned over $180,000 in the new 2024-05 tax schedule.

• When it comes to annual earned income of $200,001 per year and higher, the marginal personal tax rate will be 45 cents in each dollar over $200,000. This tax rate has remained unchanged for this income group since 1 July 2006. However, as is indicated by past media reports those in the highest income brackets in this income group are nothing if not inventive when it comes to how much or how little they pay in personal income tax.

• According to the former Morrison Government: "As a result of the Government’s plan, around 94 per cent of Australian taxpayers are projected to face a marginal tax rate of 30 per cent or less in 2024-25". 

Some of the assumptions on which Morrison and Frydenberg built their new tax system can be found at: 

https://treasury.gov.au/sites/default/files/2019-09/foi_2558_document_set_for_release_re.pdf

Cartoons of the Week

 

Cathy Wilcox

David Pope

Mark David