Recently, Australian Minister for Health, Greg Hunt, announced that Trexject® (a range of pre-filled methotrexate syringes) will be listed under the Pharmaceutical Benefits Scheme (PBS) from 1 April 2018 for those with severe rheumatoid arthritis or psoriasis. This is exciting news for people with these conditions as it provides a new way for them to access methotrexate at an affordable price.
Although Trexject® has already been approved for medicinal use and prescription in Australia by the Therapeutic Goods Association (TGA), it had not been approved for subsidy through the PBS by the Pharmaceutical Benefits Advisory Committee (PBAC). According to the media release issued by Mr Hunt’s office, without PBS listing, an average of 2,300 patients would pay around $1,093 annually (or roughly $84 every 4 weeks).

Methotrexate delivery methods

Methotrexate is a folic acid antagonist that has immunosuppressant and anti-inflammatory effects. It is considered the gold standard of treatment for rheumatoid arthritis and many other conditions. It is currently available for consumer use as an oral tablet and as a liquid to self-inject subcutaneously. The liquid form is generally prescribed for those who experience severe side-effects from the tablet form or are otherwise unable to process the medication through their digestive system. For some, this direct delivery method may be more effective in providing control of their symptoms.

Until now, consumers have only been able to access the liquid form in glass vials, from which they have to draw up their own dose using disposable needles and syringes. Many consumers are unable or uncomfortable injecting themselves in this way, so they require another person (often a GP) to draw up and inject them with their weekly dose. (Please note that methotrexate is also available for intramuscular injection or intravenous infusion for some conditions and these must be administered by a qualified medical professional.)

Changes to the PBAC listing of methotrexate

In February 2017, CreakyJoints Australia (CJA) made a submission to the PBAC to consider in its review of the listing of Trexject® (SC methotrexate) during its March 2017 meeting. Prior to writing this submission, CJA conducted a poll on this website asking readers why they felt it was important for pre-filled methotrexate subcutaneous syringes (with an embedded needle) to be made more accessible and affordable to Australians. We received 56 responses that were all in favour of supporting the inclusion of pre-filled syringes on the PBS, along with many very insightful comments.

You told us that the three main benefits you believed pre-filled syringes would provide were that:

  • They would be less fiddly than having to draw out the liquid from a vial, especially with inflamed or damaged joints in the fingers and wrists.
  • The dosage would be far more accurate. Trying to measure a prescribed dose is difficult and often results in spillage.
  • You wouldn’t need to rely on someone else to inject you. Fewer visits to the GP would also be far more cost-effective and convenient for you.

You can read the full CreakyJoints Australia submission to the PBAC here.

Outcome of the CreakyJoints Australia submission

We are pleased to say that our submission and your comments were taken into account by the PBAC.

The Public Summary Document of the March 2017 PBAC Meeting states:

“The comments from Creaky Joints Australia and the Young Women’s Arthritis Support Group also highlighted that the pre-filled syringes provided convenience in the administration of methotrexate, particularly as patients with RA may have limited dexterity and be unable to administer other forms of injectable methotrexate. The PBAC welcomed the patient comments compiled by Creaky Joints Australia. These comments reiterated the range of benefits experienced using SC methotrexate prefilled syringes.”

In addition to this, CreakyJoints Australia Patient Council member Kasey Gardiner sent a personal letter to Minister Hunt that he read out during Parliament Question Time. Kasey was quoted saying:

“I’m one of the 2,000 or so Australian patients that will benefit from pre-filled methotrexate syringes being added to the PBS. This is for rheumatoid arthritis. This listing means I can spend more time doing what I love, on what matters to me, to be with my husband and my daughter. The PBS has made this possible and, again, I just want to express my gratitude.”

This goes to show that your feedback and personal letters to policy makers help us to make a difference. Thank you!

What happens now?

Although the PBAC did approve the inclusion of Trexject® on the PBS in 2017, it was not listed immediately as the final price needed to be negotiated with the supplier, Link Medical Products Pty Ltd. This has been resolved, so Trexject® will now receive a Streamlined listing on the PBS for the treatment of those with severe rheumatoid arthritis or psoriasis for whom methotrexate oral tablets are unsuitable.

Those with psoriasis have the additional requirement that their condition must not have adequately responded to topical treatment.

A Streamlined listing means that the prescriber does not have to seek phone or written approval from the Department of Human Services (DHS) or the Department of Veterans’ Affairs (DVA). This reduces the administrative burden on the prescriber and allows them to spend more time with their patients.

Thanks to the PBS listing, from 1 April 2018, you will now only pay the standard PBS co-payment rate of up to $39.50 (or up to $6.40 if you have an approved concession card).

You can learn more about the PBS and other government benefits in our article Government pensions, benefits and services for people with chronic health issues.