艾昆纬-超越PBS：探索澳大利亚私人药品市场（英）

White PaperEvolving Beyond the PBS: Exploring Australia’s Private Medicines Market TOM HARDY, Associate Principal, Management Consulting, ANZBRIAN CHAN, Consultant, Management Consulting, ANZ YUEHUA (EMMA) YU, Senior Data Scientist, Advanced Analytics, Commercial Effectiveness Services, ANZTable of contentsIntroduction 1Data source and methodology 1Discussion 2Shifting market dynamics: The rise of non-PBS prescription sales in Australia 2ATC Class contributions: Trends in non-PBS sales growth and shifts 3The rise of private: Changing patient behaviours and emerging ecosystems 5Navigating change: Opportunities for collaboration in Australia’s private medicine market 5References 6About the authors 7 iqvia.com | 1Introduction The Pharmaceutical Benefits Scheme (PBS) is the standard funding scheme for prescription medicines in Australia. However, increasing payer pressure such as the growing use of special pricing agreements and government claimed rebates, coupled with global cost constraints caused by the Inflation Reduction Act in the United States, are prompting companies to seek funding avenues beyond the PBS. This is particularly relevant for innovation in mass-market chronic diseases such as obesity and Alzheimer’s disease. Further, primary care in Australia is being rapidly reshaped by the expanding role of pharmacists, and the prescribing of non-PBS drugs for several chronic conditions.1 In addition, primary care provision and access is becoming more fragmented with new health ecosystems, such as Eucalyptus, Wesfarmers and Woolworths offering telehealth consultations and self-funded access to prescription medicines.2,3This paper leverages IQVIA point of dispensing data and PBS codes to measure the retail non-PBS market in Australia and understand pockets of growth by therapy area.Data source and methodologyTo measure the private/non-PBS market, we have leveraged IQVIA point of dispensing data, which captures prescription medicine sales in over 4,000 pharmacy locations in Australia. PBS codes and government subsidy status within each transaction are analysed to categorise dispensations into: • PBS sales — government funded • Non-PBS sales — out-of-pocket spend on drugs that are not PBS listed• Pre-PBS sales — out-of-pocket spend on drugs that are not PBS listed at the time of sale but eventually get PBS listed2 | Evolving Beyond the PBS: Exploring Australia’s Private Medicines MarketNon-PBS sales have grown significantly in Australia, making up 15% of the total retail prescription market in 2024, compared to 9% in 2019. Pre-PBS sales accounted for 1.4% of the total retail prescription medicine market in 2024, increasing from 1% in 2019. Despite these changes, the PBS remains the predominant funding source for retail prescription medicines in Australia, though its share has declined from 92% in 2019 to 85% in 2024.In absolute terms, non-PBS sales in Australia have more than doubled since 2019, driven mainly by Anti-Obesity Medication