Ringing in the New Year with health and care changes

January

Cheaper PBS medicines

General patients will pay 29% less for PBS prescriptions from 1 January, with the maximum co-payment dropping from $42.50 to $30.

It’s the first time in 75 years the co-payment under PBS has been reduced, and Federal Government figures suggest it could save families who rely on two or three regular medications as much as $450 or more every year.

The Pharmacy Guild of Australia says about 900,000 people failed to fill their scripts in 2020-2021 simply because they couldn’t afford them. This new legislation is designed to help more people get the medications they need.

The Guild is now advocating lowering the maximum co-payment even further to $19, which would see an additional 30% of PBS medicines covered.

New PBS medications

Three new prescription drugs have been added to PBS medicine listings.

■ Trimbow (beclometasone with formoterol and glycopyrronium) which is used to treat severe asthma. Comparable treatments would cost around $1000 a year without the subsidy.

■ Vabysmo (faricimab) which combats diabetic macular oedema and neovascular (wet) age-related macular degeneration. More than 18,000 DMO patients and 62,000 people with nAMD accessed similar treatments through the PBS last year. Without the new subsidy, patients could face a $4000 medication bill each year.

■ Darzalex SC (daratumumab) to fight rare blood disorder called amyloid light-chain amyloidosis. About 160 Australians will benefit from this new treatment option which would cost more than $243,000 per course without the subsidy.

Home Care Package Program changes

There have been notable changes to pricing practices within the Federal Government’s Home Care Packages Program – the program that provides subsidies to organisations providing home care services to eligible older people.

There are four levels of Home Care Packages – from level 1 for basic care needs to level 4 for high care needs.

From 1 January, home care providers can no longer charge additional costs for thirdparty goods or services (i.e. subcontractors, labour hire); or exit fees (when a client no longer wants or requires the providers’ services).

Care Management prices (for services directly related to care such as assessing and meeting health and wellbeing needs) will be capped at 20% of the package level; while Package Management prices (for more administrative services, including financial reporting, records and staff management) will be capped at 15% of the package level.

Furthermore, providers will no longer be allowed to impose management charges in any month

Cuts to Medicare-subsidised mental health care

From 1 January the Better Access mental health initiative will be cut from 20 Medicare-subsided psychology sessions to 10.

The QNMU has concerns about this change and we are currently considering how we will respond to it.

The scheme was initially designed with only 10 sessions on offer but was expanded in the early days of the COVID-19 crisis to 20 sessions to assist people experiencing severe or enduring mental health difficulties as a result of the pandemic.

The Federal Government has decided to roll back the number of Medicare-supported sessions after where a client only receives care management (except for the first month).

If, as a result of these new laws, there is any decrease in a client’s care package and management package prices and/or removal of separate third-party services, the provider must simply inform their client of the changes with 14 days prior notice.

However any increase in costs as a result of these new laws must be discussed and mutually agreed with clients and documented in the home care agreement before the new rates are charged.

The legislation states the prices and any price increases must be “reasonable and justifiable” – although there is no formal definition for this.

There are of course other changes in the Aged Care space due to be rolled out in 2023 including the requirement for aged care facilities to have an on-site and on-duty registered nurse 24/7 (from 1 July) and the introduction of 200 mandatory minutes of care per resident per day (starting 1 October).

Queensland tax to support mental health

In Queensland, new payroll tax changes came into effect on 1 January implementing a 2022-23 Queensland Budget provision. These tax changes will create a new mental health levy to improve mental health and combat substance abuse.

Large employers and employer groups with annual national payrolls of more than $10 million will be liable to pay a mental health levy of 0.25 cents in the dollar for wages over $10 million, and 0.75 cents per dollar for wages over $100 million, taxed at a marginal rate.

It’s expected about 6000 Queensland businesses will pay the new tax netting about $1.64 million over five years.

Covid-19 testing changes

To clear up any confusion, a reminder that PCR tests remain free for everyone who needs one if their GP or nurse requests one for them, or at GP-led Respiratory Clinics or state- or territory-run COVID-19 testing centres.

a University of Melbourne review into the program concluded it had caused longer waiting times and had reduced access to new and low-income patients. There are serious concerns around equity of access.

Critics however said it was shortsighted to assume the pandemic is no longer having an impact on mental health and argue the report also stated the Federal Government should continue to fund the 10 additional sessions but target them towards those with complex mental health needs as a way of helping address a national shortage of psychological services.

Priority populations can access them free through state testing sites. Priority populations include the elderly, First Nations people, people with disability, people who are immunocompromised or with complex underlying health conditions, people living in remote communities and people from CALD communities.

Everyone else can continue to receive PCR testing free of charge through GPled respiratory clinics.

They are also free of charge when a GP or nurse practitioner requests a test from a pathology provider as part clinical management. In this situation the tests, provided out-of-hospital, must be bulk-billed by the pathology provider.

The aim is to encourage lower risk people to use home-use Rapid Antigen Tests (RATs) to determine contagion and then follow the normal COVID-19 control protocols of rest, isolation and good hygiene.