To access to Direct Acting Antivirals to treat hepatitis C you need a doctor to prescribe them for you. You also need a pharmacy, or drug store, to dispense the drugs. Drugs to treat chronic conditions like hepatitis C have always been dispensed in Australia through the Section 100 – Highly Specialised Drugs Program. Because of their clinical use or other special features, medications like interferon and ribavirin are restricted to supply through public and private hospitals with appropriate specialist facilities. Medical practitioners are required to be affiliated with these specialist hospital units to prescribe these drugs under the scheme.
While treating specialists often run part-time clinics for patients in rural and remote areas, dispensing the drugs has been an enormous and ongoing problem. In some parts of Australia it requires an eight hour drive to get the nearest and dispensing pharmacy. For someone on interferon and ribavirin, this could be a harrowing journey.
Thankfully things have changed with the new listing of Sovaldi, Harvoni, Daklinza and Ibyvir. Not only are General Practitioners able to prescribe them (in consultation with a liver specialist) but community, or local, pharmacies can now dispense the drugs. This means that there is no need for anyone with a prescription to travel further than their local pharmacy to access the cure for hepatitis C. Better yet, the cost of these drugs is heavily subsidised by the Australian Government. The required co-payment is no more than the cost of a regular prescription and even less for people on benefits.
This is a revolution in access to hep C treatment. It is a huge benefit for everyone who needs to access treatment, but in particular it will make access to treatment much easier for Aboriginal people and others in remote communities. Aboriginal people are significantly overrepresented in people living with hepatitis C.
Already a number of community pharmacies have a begun dispensing these drugs. With the number of people requiring hep C treatment, we will need many more to come on line this year. But it is important to realise that this is a massive financial commitment for a small business like a community pharmacy.
Community pharmacies must buy the drugs in from the manufacturer at their full cost. Once they have dispensed them and you have paid your nominal co-payment, the pharmacist will seek reimbursement from the government for the cost of the drugs. With a couple of patients, the pharmacist could easily be out-of-pocket for a few hundred thousand dollars while waiting for the reimbursement to come through. For this reason, not all pharmacies will be willing to dispense the new hep C drugs.
If you are considering undergoing hep C treatment, talk to your pharmacist. Having a good relationship with the pharmacist will make it easier when you want the drugs dispensed.
Community pharmacy dispensing is a huge step forward in improving access to hep C treatment. Hopefully it will soon be replicated in other places.
The views expressed above are mine alone and not necessarily those of my employer