弥合分歧：衡量药品改革协议对药品获取的影响

Bridging the Divide: Measuring theImpact of the Pharmaceutical ReformAgreements on Medicine Access A data-driven analysis of how PRAs shape equity, access, andcare integration across Australia LELIN ZHANG, Associate Principal, IQVIA Management Consulting ANZMARCO LAU, Consultant, IQVIA Management Consulting ANZTHOMAS AYLETT, Associate Consultant, IQVIA Management Consulting ANZ Table of contents Background and objectives Discussion3 Impact of PRAs on dispensation pattern3Disparity in ATC classes dispensationpatterns3Deep dive on high-cost medicine dispensation in pubic hospitals6Geographical and infrastructureinfluences6 References About the authors9 Introduction The Pharmaceutical Reform Agreements (PRAs) are bilateral agreementsbetween the Commonwealth and relevant jurisdictions that facilitate the accessof Pharmaceutical Benefits Scheme (PBS) medications for admitted patientson discharge, non-admitted patients and same day admitted patients in publichospitals.2Assessing disparities in the uptake and impact of PRAs is critical tounderstanding how policy differences across Australian states and territoriesinfluence equity of access, system efficiency and patient managementpathways. The PRAs framework complements Australia’s efforts to graduallyintegrate elements of value-based healthcare1with the key goal of enhancingprovider and patient outcomes while improving equity of access. Background and objectives New South Wales (NSW) and Australian CapitalTerritory (ACT) are yet to sign on due to state specificconsiderations. In addition, Western Australia(WA) is currently not a signatory to the HospitalReform component of the PRAs, hence, WA publichospitals do not routinely access PBS medicationsat commonwealth subsidised prices and face similaraccess challenges to NSW and ACT. Using IQVIA’s national data assets, this paper examineshow PRAs participation influences medicine accessacross jurisdictions — revealing practical insights forimproving equity and system efficiency. Building on this perspective, the paper examines howthe location of medicine dispensation — whether inhospital or community settings — varies betweenPRAs signatory and non-signatory regions. It exploresthese patterns across different channels, cost profiles,therapeutic areas, and geographic contexts, offeringinsights into how PRAs participation influencescareintegration. Key jurisdictions that have signed PRAs includeQueensland (QLD), Victoria (VIC), Tasmania (TAS),South Australia (SA) and Northern Territory (NT). Thesestates and territories benefit from uniform pricingthrough nationally negotiated drug prices, supplysecurity guarantees and cost recovery for governmentvia confidential rebates.2 Data Source and methodology To explore the impact of PRAs on dispensation pattern,we have leveraged 2 main IQVIA data sources: IQVIA data sources IQVIA’s hospital PROFITs datawhichcaptures volume from wholesalers toindividual hospital pharmacies, coveringapproximately 97% of volume dispensedin Australia. Molecule selection criteria The analysis focuses on 153 molecules across 39 ATC3classes that meet the following criteria: IQVIA point of dispensing data, whichcaptures prescription sales in over 4,000community pharmacies. The numberof packs dispensed in communitypharmacies that can be linked backto a hospital doctor is reported in anaggregated manner in this report. •With over 50% of community volume linked back toa hospital with minimum 200 unit sold in12 monthperiod. •Dispensed in both hospital and community settings. •Excludes medicines requiring compounding (e.g.,monoclonal antibodies, chemotherapy) due toincompatible unit measures. These sources allow for a comprehensive view ofhospital-prescribed medicines, regardless of whetherthey are dispensed in hospital or community settings. Definitions and classifications Anatomical TherapeuticChemical (ATC)classification system High-costdrug Metropolitan vs.remote area The PBS Safety Net thresholdfor general patients is $1,694.00per year6updated on 1 January2025. Monthly spending of $140over 12 months would exceed thethreshold, especially for chronicconditions, thus qualifyingdrugs as high-cost in terms ofcumulative patient expenditure. Developed by the World HealthOrganization (WHO) to categorisemedicines. IQVIA used ATClevel 3 to classify medicinesbased on organ or system theyact on, therapeutic use andpharmacological subgroup. Australian Bureau of Statisticsuses a classification systemcalled the Australian StatisticalGeography Standard (ASGS) tocategorise areas as metropolitan(major cities), rural, and remote.5 Discussion Impact of PRAs on dispensation pattern requires patients to take additional steps to accessongoing treatment through external providers,potentially disrupting continuity of care. We willexplore the differences and similarities in this section. PRAs play an important role in the patient’s journey,especially when they are transitioning from hospitalto