The pricing of statins and implications for Pharmaceutical Benefits Scheme expenditure

To the Editor: Following two articles in the Journal,1,2 I wish to provide an update on the pricing of statins in Australia and the implications for Pharmaceutical Benefits Scheme (PBS) expenditure. I was prompted to do so by a recent review by the Pharmaceutical Benefits Advisory Committee (PBAC), which was instigated by the Senate when it passed legislation enabling the current pharmaceutical pricing arrangements.3 The purpose of the review was to determine if there was new evidence on whether rosuvastatin and atorvastatin should be included in the existing statins therapeutic group.

A summary of the PBAC review, which was released publicly in August 2012, reaffirmed previous recommendations that atorvastatin and rosuvastatin are more effective than simvastatin in lowering cholesterol levels.4 It also noted that the current evidence did not change the PBAC’s previous advice that only an average price differential of 12.5% between atorvastatin and simvastatin was acceptable.4 This has important implications, as the ex-manufacturer price of simvastatin has fallen significantly following the first round of price disclosure to between $9 (20 mg) and $19 (80 mg),5 thus increasing the price differential. Unfortunately, the recent 25% voluntary cut in the price of atorvastatin by the manufacturers is not sufficient to meet the PBAC recommendation. The ex-manufacturer price of the most commonly prescribed dose of atorvastatin (40 mg) fell from $51 to $38 on 1 December 2012, but the price for determining PBS subsidy that the PBAC would consider acceptable (assuming that it is set at the average recommended differential) would be around $21. Applying the PBAC recommendations in full would save taxpayers and consumers about an additional $260 million annually (calculated by applying PBAC recommended prices to the quantities of each dose of atorvastatin and rosuvastatin prescribed on the PBS in 2011–12).

But even if the PBAC recommendations for atorvastatin pricing were implemented, the cost in Australia would be many times higher than other comparable countries (eg, patients in New Zealand currently pay less than A$2 per month). Similar international price differentials now exist for several other therapies for which patents have recently expired (Box). This emphasises the need for substantial reform of the current pricing policies to ensure value for money when purchasing pharmaceuticals through the PBS.

International price comparison of ex-manufacturer prices of selected therapies*

* Data were obtained from the Pharmaceutical Benefits Scheme (Australia), Pharmaceutical Services Negotiating Committee (Category M) (England), the Dental and Pharmaceutical Benefits Board (Sweden) and the Pharmaceutical Management Agency (PHARMAC) (New Zealand). Comparisons are based on average exchange rates between the 2010 and 2012 calendar years. † Price of atorvastatin in Australia takes into account the 25% price reduction that occurred on 1 December 2012.