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Shadowfeet
Member in Phase 2
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Posted: Wed Nov 14th, 2007 13:46 |
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Angelina Argentina wrote: much to our dismay... (re hcf)
http://www.mosaichouse.com.au/psb_query.htm
oops.
Angelina, that is the same as the letter I got from HCF.
I still don't really understand it though - I thought that most medications were available on the PBS, so that couldn't really be a reason for a private health fund not to cover a medication??
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CFS Thyroiditis Endometriosis Raynauds 125D34 25D<7Dec07 Effexor Lyrica thyroxine clonazepam OCP NoIRs limited outings covered up Ph1Sep07 ModPh2Dec07 Ph2May08
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Moxie
Member in Phase 2/3
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Posted: Thu Nov 15th, 2007 00:53 |
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That is how this health fund has written its policy and I can see why. If the drug is on PBS, they are not going to cover the full cost of it. The way scripts are written for us (previous to the new information on this thread) they were called non PBS and we had to pay full price.
Looking at what has been written by the GP on this thread, we should be able to access this drug on PBS script and have more money to spend on Christmas!!
All very confusing but we have come a l-o-n-g way with the cost of this drug in the past 12 months.
Moxie
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CFS 25 years - FMS. Benicar 3 daily - Ph 2 16/5/05 - Ph 3 10/5/06 Metformin 500mg 1/2 bd. Vit D 45nmol/L (18ng/ml) 1,25 D 92pmol/L (38.3pg/ml)
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Grace
Member in Phase 3
| Joined: | Tue Sep 14th, 2004 |
| Location: | Australia |
| Posts: | 396 |
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Posted: Fri Nov 16th, 2007 02:24 |
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My girls have just got their olmetec on a PBS concession costing $4.95 for 120tabs.
I beleive us Aussie MPers should give ourselves a pat on the back,and thank you to all those who have help with letters and inquires etc
This thread started Nov 2004.In 3 yrs we have gone from getting benicar by sending faxes to Germany, waiting for postage (always a worry), and costing $180 for 90tabs with no rebate.Then compounding costing $90 with still ordering and waiting for the post, and some getting a rebate.To what we always really wanted and needed, benicar/olmetec on the PBS for every MPer.
This has now really open the flood gates for MP in australia. Now that people can not only afford benicar/olmetec, but it has given MP creditability for 'main stream' medicine.As people, and their doctors feel more comfortable with getting a prescribe medication from the local chemist that they can afford and is recognise by the PBS.
Dr Trevor Marshall thank you  (and are you ready )
Grace
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CFS, oct04 Ds=26/48, 4/07=7/24 MP PHI 2/05, PhII 6/05, PhIII 6/06, beni Q6H, Noirs rarely inside no nature light low watt, outside 40%10%, Hat, all covered, no gloves, paracetamol
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Dr Trevor Marshall
Research Team
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Posted: Fri Nov 16th, 2007 02:31 |
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You bet I'm ready 
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scooker48
Member in Phase 3
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Posted: Fri Nov 16th, 2007 22:37 |
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Does this help people living in the USA? Can we buy the Benicar from a vendor in Australia? Or is this part of your health coverage?
With joy for everyone down under,
Sherry
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Necrotizing granulomas biopsy 10/88; Dx 12/04 Sarcoid liver spleen. 2/2/05: VitD 25/VitD125 62. 5/9/09 D25, D3 6; D25 D2 <4, Liver function normal 4/08; Wear NoIRs outside. No K creme used. 5/09 Liver and kidneys normal.
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Vicki SA
Member in Phase 3
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Posted: Sat Nov 17th, 2007 02:22 |
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G'day Sherry,
No it won't help anyone other than Australians. Medications can be approved and are then subsidised by the government to make them more affordable. People entitled to Concession Status get them very cheaply around $5 and everyone else will pay around $30.
Cheerio Vicki
PBS
Schedule of Pharmaceutical Benefits is a listing of the medicines subsidised by the Australian Government. The Schedule is part of the wider Pharmaceutical Benefits Scheme administered by the Department of Health and Ageing and Medicare Australia.
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ME/CFS 2000, Splenectomy, 8/05 - 1,25D51,25D16.5, Ph1 12/05, Ph3 1/07, Zoton 30mg, 2008 - cover with light r/t Work 3/7, NoIRs, hat, cover well, invis. zinc for outside, low lux home, Sept08 25D - 8
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Joolz
Member in Phase 2
| Joined: | Fri Jun 29th, 2007 |
| Location: | Australia |
| Posts: | 57 |
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Posted: Sat Nov 17th, 2007 04:00 |
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Hi,
I tried getting a rebate from MBF for Olmesartan but they refused. I have an Extras Policy. At first they said it is because it is PBS med. Then I got my Doctor to write them a letter explaining what it was prescribed for and they refused again saying their own doctor wouldn't approve it for such a use. They queried the high doses. Does the Authority Script mean it is PBS but the script needs to be written differently?
Thanks
Joolz
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CFS, hypothyroid MP1/07, Ph2 12/12/07,Thyroxine,rivotril, NoIRS 1,25D 60.42, 25D 5.2
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Vicki SA
Member in Phase 3
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Posted: Sat Nov 17th, 2007 05:32 |
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ndodd wrote: Hi Shadowfeet
There is good news for you and other Aussie MPers.
Olmesartan is now on the PBS. This means that you can ask your doctor for an 'Authority script' for one months supply, with six repeats. The cost will be the same as for one pack of 30 tabs.
I just checked with the Authority approvals people by phone to confirm this. It is not necessary for you to have hypertension.
This doesnt help you with rebates on previous scripts, but it will help for future scripts.
Cheers Nyrie
[GP in Sydney, Australia, MP prescriber since 2006]
G'day Joolz,
The post quoted from 3rd Novemeber should help!
Cheerio Vicki
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ME/CFS 2000, Splenectomy, 8/05 - 1,25D51,25D16.5, Ph1 12/05, Ph3 1/07, Zoton 30mg, 2008 - cover with light r/t Work 3/7, NoIRs, hat, cover well, invis. zinc for outside, low lux home, Sept08 25D - 8
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Vicki SA
Member in Phase 3
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Posted: Sat Nov 17th, 2007 05:58 |
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Information from Nyrie Dodd GP for you and your Dr.
ndodd wrote: >>>>>>
Olmesartan is an unrestricted benefit on the PBS, ie its cost is subsided by the Australian Government, and its use is not restricted to a particular condition. As you know, the price of PBS scripts is capped at around $30 and around $4.95 for concession card holders. Unrestricted benefit means that you do not have to have hypertension to qualify for the PBS subsidy.
There is not much point getting a PBS script for 30 tabs for $30, cos this is pretty close to the private price. However an Authority script can get you 120 tabs for $30. Or if you are on 5 tabs/day, your doc can prescribe you 150 tabs per month.
This means that you can ask your doctor for an 'Authority script' for one months supply, with six repeats. The cost will be the same as for one pack of 30 tabs.
I just checked with the Authority approvals people by phone to confirm this. It is not necessary for you to have hypertension. There is currently no PBS restriction to hypertension.
I might put immunopathology and hypertension where someone has both conditions.
I might also put hypervitaminosis D where someone has high 1,25D.
I put a PBS Authority script for 120 tabs and 5 repeats through the phone approval just now using the indication of 'immunopathology'.
I believe the intention of the Authority system is also to allow a levelling of the cost for patients on larger than normal doses. I use the Authority approval system for any script when the patient is on more than one pack per month , eg eczema creams, antidepressants, antipsychotics, diabetic medication, herpes prevention, and even sorbolene (five tubs per month!).
Nyrie
[GP in Sydney, Australia, MP prescriber since 2006] <<<<<<
Further Information:
On page 2 of the Benicar insert says, "Olmesartan shows linear pharmacokinetics following single oral doses of up to 320 mg and multiple oral doses of up to 80 mg." Which means that there is no further increase in the decrease of blood pressure with higher amounts than RDA. And that it has been tested safe to 320 mg per day... twice the maximum taken with the MP protocol.
The palliative effects come into play, which are not written up on that insert making Benicar safer on the amount used with the MP protocol than with less.
information on Benicar called "FDA Safety Insert", most important pages are Pages 4, 5, 9 & 10 - pages 4 & 5 show that blood pressure is not reduced further with increased dosing, and pages 9-10 say that dosage must be individualised, and high doses are well tolerated.
It isn't safe to start the Marshall Protocol until you have an adequate supply of Benicar on hand and your doctor's permission to increase to 40mg every four hours if symptoms become intolerable. Please discuss this issue with your Dr before you begin.
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ME/CFS 2000, Splenectomy, 8/05 - 1,25D51,25D16.5, Ph1 12/05, Ph3 1/07, Zoton 30mg, 2008 - cover with light r/t Work 3/7, NoIRs, hat, cover well, invis. zinc for outside, low lux home, Sept08 25D - 8
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lionel forbes
Member in Phase 3
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Posted: Mon Nov 19th, 2007 06:52 |
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| here is the result of my enquiries to helth ins co.s. out of ahm, manchester, nib hcf rj, nib has best deal-$ 60 per script max 600 p.a. (source- i Select). medicare-useless, mbf $50per script max $300 westfund same, aust unity same, those quoted above accept compounded meds.
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sarcoidosis phase 1 jan 2006,phase 2 march 2006, phase 3 september 2006
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healingjason
Member in Phase 3
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Posted: Wed Nov 21st, 2007 07:00 |
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ndodd wrote: Hi Robert,
I put a PBS Authority script for 120 tabs and 5 repeats through the phone approval just now using the indication of 'immunopathology'.
I might put immunopathology and hypertension where someone has both conditions.
I might also put hypervitaminosis D where someone has high 1,25D.
There is currently no PBS restriction to hypertension.
However, the statistics might eventually get back to the pharmaceutical co, who might respond in a helpful way. Eg, reps discuss Vit D metabolism with GPs, or sponsor a conference, or develop a 24hr slow release in several strengths, campaign against fish oil, etc etc
Heres hoping anyway.
Nyrie
Hi Nyrie
Being a bureacarat, I have trawled through the PBS website and understand the Olmetec PBS rules to be as follows:
1. one packet of Olmetec containing 30 x 40mg blister capsules with 5 repeats can be dispensed by any doctor (or dentist) for any therapeutic use and attract PBS benefits - eg $4.95 per packet for health care card holders. Thus, 6 months of MP use can be acquired without any PBS authority scrutiny or oversight. This qualifies as an unrestricted PBS benefit
2. for more than 5 repeats (or more than 6 months MP use), a PBS authority is required by the prescribing doctor by mail or telephone. I gather you have been able to secure this authority over the telephone for uses other than hypertension and have used the terms 'immunopathology' and 'hypervitaminosis D' to achieve this.
This is very surprising to me and implies that the PBS authorities are (at present)either indifferent to what doctors want to use the Olmetec for or have accepted these conditions as valid medical conditions warranting the use of this drug. I suspect the former applies and I fear that it will only be a matter of time before the accountants discover that too much taxpayer money is being spent on off-label use of Olmetec. Do you have any information to suggest the PBS is aware of the therapeutic efficacy of Olmetec for other than hypertension?
Our doctor has been under investigation for supposed inappropriate long term prescribing of antibiotics and is very wary of prescribing Olmetec on the PBS. Would you be able to assure him that prescribing Olmemtec in the way you have is not controversial?
Cheers
John
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Dad of Jason, 12 yrs autistic boy. Chronic intra-cellular infection evident from abnormal urinary amino acids, as found by the Uni of Newcastle, Australia. Benicar 40 mg QW8H from 7 Apr 07. Phase 3 from 28 June 08. Covered up, sunscreen. 25D 10 (08/09).
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ndodd
Health Professional
| Joined: | Thu Aug 17th, 2006 |
| Location: | Sydney, Australia |
| Posts: | 64 |
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Posted: Wed Nov 21st, 2007 11:01 |
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Hi John
The PBS listing for Olmesartan is a big change for MP prescriptions in Australia.
Olmesartan is an unrestricted benefit on the PBS, ie its cost is subsided by the Australian Government, and its use is not restricted to a particular condition. As you know, the price of PBS scripts is capped at around $30 and around $4.95 for concession card holders. Unrestricted benefit means that you do not have to have hypertension to qualify for the PBS subsidy. The MP is not an 'off-label use' because olmetec doesnt have a labelled use in Australia.
However Olmetec Plus (olmesartan with a diuretic) is a restricted benefit. Its use is restricted to hypertension. It is not used on the Marshall Protocol. Sweet!
As you will all know too well, before PBS listing, which occurred this year (?maybe in August, 2007), you had to buy Olmesartan on a private script and pay the full cost yourself. If you had private extras cover, you could hope that your health fund would rebate you something. As several people have found out, once a drug is listed on the PBS, the private rebate disappears. Statistical information on private scripts is not recorded.
The Authority Approvals process can provide one months suppply of a drug, for the PBS cost of one pack. It is also used to restrict some drugs to certain conditions,eg in osteoporosis, H pylori eradication, HIV treatment etc etc.
I believe the intention of the Authority system is also to allow a levelling of the cost for patients on larger than normal doses. I use the Authority approval system for any script when the patient is on more than one pack per month , eg eczema creams, antidepressants, antipsychotics, diabetic medication, herpes prevention, and even sorbolene (five tubs per month!).
IME, most pharmacists worth their salt will tell the patient to go back to the doctor and get an Authority script, rather than buy one pack every week. Many many prescription drugs are expensive, far more expensive than olmesartan, and most Australians never have to find this out for themselves. Just check any online pharmacy for the Private price of say Enbrel, or Famvir, or Pegatron or Combivir. Most non MPers using Angiotension Receptor Blockers are planning on taking them for a lifetime. Compared to this , even ten years on the MP is very cheap.
There is not much point getting a PBS script for 30 tabs for $30, cos this is pretty close to the private price. However an Authority script can get you 120 tabs for $30. Or if you are on 5 tabs/day, your doc can prescribe you 150 tabs per month. And so on. You can do this for as long as it takes you ( ie your son) to get well.
I cannot comment on your doctors situation re being investigated for longterm use of antibiotics. I know from experience that any investigation is stressful. However hopefully he/she will prescribe what is in your best interest. Isnt that their job?
If your doctor is prescribing the MP, but not really proud or excited about that, then maybe they dont quite get it. But if and when they do, its gonna be a OMG moment.
Ah, the sociology of paradigm shifts...
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Mild RA 9 yrs: Nov07 125D 38, 25D 18; Ph1 Dec07; Ph2 Jan08, 25D 8; Ph3 May08, 25D7; NoIRs outdoors,hat,gloves
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lionel forbes
Member in Phase 3
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Posted: Fri Nov 23rd, 2007 06:29 |
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| wheni first asked my doctor to supervise me on mp, she said that she needed a positive response from her liability insurance company. that company told her that it will be no problem providedthat my lung specialist agreed to supervise me on mp also, which he did. so now she feels entirely comfortable ,including prescribing all the meds, for 2 years now.
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sarcoidosis phase 1 jan 2006,phase 2 march 2006, phase 3 september 2006
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ndodd
Health Professional
| Joined: | Thu Aug 17th, 2006 |
| Location: | Sydney, Australia |
| Posts: | 64 |
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Posted: Fri Nov 23rd, 2007 14:33 |
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Lionel
I think that that is called 'defensive' medicine, ie to only practise what your liability insurance company says is defensible.
Its an American import.....
Baa, baa
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Mild RA 9 yrs: Nov07 125D 38, 25D 18; Ph1 Dec07; Ph2 Jan08, 25D 8; Ph3 May08, 25D7; NoIRs outdoors,hat,gloves
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lionel forbes
Member in Phase 3
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Posted: Mon Nov 26th, 2007 06:57 |
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| if i was a doctor i would do the same,to protect myself against being sued.from my doctors point of view, the mp is not recognised by the medical profession, so any claim would normally not be accepted by her ins co.
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sarcoidosis phase 1 jan 2006,phase 2 march 2006, phase 3 september 2006
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OurMiraculousHealing
Banned
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Posted: Mon Nov 26th, 2007 12:23 |
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Two thumbs up for Ndodd and professionals like him who practice healing and not medicare or politics.
Amelia
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’95 Numerous medical(mis)diagnoses/ No sun, NoIRS, coverup (hat,gloves,blockout)/40mg Olmetec 6hrly/D-free diet/1,25D31, 25D18
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Fred
Member in Phase 2
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Posted: Mon Nov 26th, 2007 12:26 |
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| I liked ndodds baa baa. Its what this place needs, a bit more humour.
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CFS gout 125D55 25D30 Ph1Sep07 ModPh2Dec07 Ph2Jan08 25D19 (Jan08) 25D18 (Mar08) 25D 14 August(08) NoIRs rare outings covered low lux home|
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lionel forbes
Member in Phase 3
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Posted: Tue Nov 27th, 2007 06:18 |
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| yup
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sarcoidosis phase 1 jan 2006,phase 2 march 2006, phase 3 september 2006
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Scarab
Member in Phase 3
| Joined: | Thu Aug 10th, 2006 |
| Location: | Sydney, Australia |
| Posts: | 160 |
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Posted: Wed Nov 28th, 2007 19:54 |
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| Yup alright.... but to correct a point.....ndodd is very much a woman.
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Sarc Aug06|CFS June90| Avoid light&D NoIRs Beni40mg q6h Sept06 mino Sept06| Aug06 1,25D-57.5 25D-20 Apr07 25D-5 Apr08 25D-4| Aug 07 2% NoIRs outside only, Average 30mins per day outside K&16% zinc.
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OurMiraculousHealing
Banned
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Posted: Thu Nov 29th, 2007 00:06 |
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| better still, hey?!
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’95 Numerous medical(mis)diagnoses/ No sun, NoIRS, coverup (hat,gloves,blockout)/40mg Olmetec 6hrly/D-free diet/1,25D31, 25D18
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