Medication copayment subsidy for First Nations peoples

1. Purpose
2. Scope
3. Principles
4. Outcomes
5. Mandatory requirements
6. Related or governing legislation, policy and agreements
7. Supporting documents
8. Business area contact
9. Review
10. Approval and implementation
11. Human rights
12. Definitions of terms used in this directive
13. Version control

1. Purpose

This Health Service Directive (HSD) directs Hospital and Health Services (HHSs) in Queensland to provide copayment subsidy to First Nations consumers of Queensland Health (QH) for medications dispensed by QH public hospital pharmacies. It describes QH’s efforts to adopt key tenets of the Commonwealth Government Closing the Gap Pharmaceutical Benefits Scheme (PBS) medication copayment subsidy measures into the public hospital setting.

2. Scope

This HSD applies to all Hospital and Health Services.

3. Principles

• The Health Equity Reform and Closing the Gap are core objectives of the Queensland Government and Queensland Health.
• The Queensland Government supports and actively contributes to national objectives and policy responses to achieve Closing the Gap outcomes.
• Medication access and adherence are key to improved health outcomes for First Nations peoples.
• A specific initiative is required for treatment provided through public hospitals, as the Commonwealth prohibits public hospital pharmacies from utilising the main Closing the Gap co-payment measure when dispensing medication.
• Queensland Health acknowledges the interface between hospital and community care and is cognisant of the need to sustain the respective roles and strengths of each.
• Queensland Health encourages First Nations people to access healthcare and medications as close to home as possible, and, in the case of medications, from their community pharmacy.
• Queensland Health actively informs First Nations peoples about, and encourage access to, benefits available under Commonwealth Government Closing the Gap programs.
• Keeping Queenslanders out of hospital and reducing emergency hospital reattendance.

4. Outcomes

Hospital and Health Services included in the scope of this HSD will achieve the following outcomes:

• maximise access to essential medications for First Nations patients;
• support the achievement of Closing the Gap outcomes and realisation of QH Health Equity Strategies; and
• streamline processes for consumers to obtain access to medication without the need for multiple unnecessary additional appointments to obtain subsidised medications.

5. Mandatory requirements

• Hospital and Health Services will waive, in full, co-payments for all medicines prescribed by Queensland Health prescribers on hospital prescriptions, when dispensed by hospital pharmacies, to First Nations patients:
  • upon discharge, following an admitted episode of care, including presentation for emergency care; and
  • whilst under the care or treatment of a Queensland Health specialist outpatient service, where the patient cannot readily access their medicines from a community pharmacy.
• Medicines included in the directive include those not covered by the Commonwealth scheme, such as Section 100 Highly Specialised Drugs and any approved non-PBS medicines.
• The principles of the Queensland Health List of Approved Medicines, and related activities such as Individual Patient Approvals, will be upheld.
• Wherever possible a full supply of PBS medications will be provided, or an amount that is clinically necessary, whichever is the lesser.
• Eligible patients will be those identified as First Nations in HBCIS, or otherwise identifying as such (in which case HBCIS should be updated).
• Queensland Health encourages subsequent (repeat) medication supplies for Section 85 PBS items to be dispensed via a community pharmacy, under CTG arrangements, noting that this would incur a higher out-of-pocket cost for general (but not concession patients).

6. Related or governing legislation, policy and agreements

• Hospital and Health Boards Act 2011
• National Health Act 1953
• National Health (Closing the Gap – PBS Co-payment Program) Amendment Special Arrangement 2021
• Human Rights Act 2019

7. Supporting documents

• Queensland Health Fees and Charges Register.
• Medications co-payment subsidy for First Nations patients - Queensland Health Work practice (under development).

8. Business area contact

• Andrew Jagels, Director, Medication Services Queensland, Health Protection and Regulation Branch, Queensland Public Health and Scientific Services.

9. Review

This HSD will be reviewed at least every three years, or sooner if the Commonwealth amends the supporting Special Arrangement.

Date of last review: N/A – New Directive

Supersedes: N/A

10. Approval and implementation

Directive Custodians

• Haylene Grogan, Chief First Nations Health Officer, First Nations Health Office
• Nick Steele, Deputy Director-General, Queensland Public Health and Scientific Services

Approval by Chief Executive

Issued under section 47 of the Hospital and Health Boards Act 2011.

11. Human rights

Human rights have been considered as a part of this process, specifically as they relate to Section 28 Cultural Rights – Aboriginal peoples and Torres Strait Islander peoples and Section 37 – Right to Health Services.

12. Definitions of terms used in this directive

13. Version control