Effect and illustrative costs of downscheduling on government subsidised dispensings of triptans in Australia: a 10-year analysis.

Objective Acute migraine episodes affect >18% of Australians. Triptans are most effective when taken early in migraine attacks, making timely access critical. Before February 2021, triptans were prescription-only, but a downscheduling policy change enabled over-the-counter (OTC) purchase with pharmacist advice. This study examined the effect on subsidised Pharmaceutical Benefits Scheme (PBS) dispensing rates and illustrative patient costs. Methods Aggregated PBS dispensing data were used to estimate monthly triptan dispensing rates per 1000 people using population data from the Australian Bureau of Statistics. As PBS data excludes OTC supply, we projected dispensings, and illustrate potential costs based on pre-downscheduling trends to estimate the potential shift to OTC. PBS beneficiaries include concessional (social security recipients/low-income earners) and general (those ineligible for concessions). Prescription costs were based on a four-tablet PBS pack of sumatriptan 50mg (A$7.70 concessional; up to A$24.60 general). OTC costs were estimated using a two-tablet pack (A$10.00 standard pharmacy, A$7.00 discount pharmacy). Results Before downscheduling, triptan dispensings grew 1.4% monthly, slowing to 0.6% post-downscheduling. By illustration, we estimate that shift to OTC access would have led to a cost saving of up to A$2million for general patients, but an increased cost of A$2.3-5.8million for concessional patients, depending on pharmacy pricing models. Conclusion Downscheduling slowed PBS dispensing growth. If reduced PBS dispensing was offset by OTC access, the policy may have improved timely migraine treatment, although PBS use remains high. Cost benefits depend on patient concession status and potential offsets, such as reduced doctor visits, which should be considered in further policy evaluations.