Robertson Jane, Walkom Emily J, Henry David A
Clinical Pharmacology, University of Newcastle, Calvary Mater Hospital, Waratah, Newcastle, NSW 2298.
Aust Health Rev. 2009 May;33(2):192-9. doi: 10.1071/ah090192.
Australia's system for assessing the cost-effectiveness of drugs for listing under the Pharmaceutical Benefits Scheme (PBS) is recognised internationally. A variety of mechanisms, such as evidence-based rules for determining eligibility for initial or continuing subsidy, price-volume agreements, rebates, and caps on government expenditure are used to contain PBS expenditures. In this paper we assess the extent of use of special pricing arrangements in Australia and how and where they are communicated to health professionals and the community. We searched publicly available documents published by the Pharmaceutical Benefits Advisory Committee (PBAC) and the Pharmaceutical Benefits Pricing Authority (PBPA). We found 73 medicines where special pricing arrangements had been applied and where prices appearing on the Schedule of Pharmaceutical Benefits might differ from those considered to be "cost-effective" by the PBAC. Reporting of these special pricing agreements was inconsistent and generally non-transparent. In some, the lack of transparency may have reflected the desire of manufacturers to disguise the true negotiated price, lest it weaken their negotiation position in other jurisdictions.
澳大利亚评估药品列入《药品福利计划》（PBS）的成本效益的体系在国际上得到认可。澳大利亚采用了多种机制来控制PBS支出，比如基于证据的规则来确定初次或持续补贴的资格、价格-数量协议、回扣以及政府支出上限。在本文中，我们评估了澳大利亚特殊定价安排的使用程度，以及它们如何以及在何处传达给医疗专业人员和公众。我们搜索了药品福利咨询委员会（PBAC）和药品福利定价局（PBPA）发布的公开文件。我们发现有73种药品应用了特殊定价安排，且《药品福利清单》上出现的价格可能与PBAC认为“具有成本效益”的价格不同。这些特殊定价协议的报告并不一致，且总体上不透明。在某些情况下，缺乏透明度可能反映了制造商想要掩盖真正谈判价格的愿望，以免削弱他们在其他司法管辖区的谈判地位。
