Pharmaceuticals for people seeking asylum

Access to medication is essential for health care.

There have been challenges to the continuity of health care for people who are asylum seekers recently with changes in case work service providers (now Status Resolution Support Service – SRSS), changes in payment arrangements and lapses in Medicare entitlements.

People who are asylum seekers will have varying costs for pharmaceuticals depending on their entitlements, as described in the table below:

	No Medicare	Medicare
No SRSS provider	Full price of medication. No safety net.	PBS rate, usually not in excess of $37.70 for medicine lasting at least one month. Safety net threshold (2015) $1,453.90
SRSS proivder	SRSS providers will establish relationships with pharmacies that will provide the medicine prescribed by GP (on script) for $6.10 (equivalent to Health Care Card rate). Concessional safety net applies of (2015) $366.	SRSS providers will establish relationships with pharmacies that will provide the medicine prescribed by GP (on script) for $6.10 (equivalent to Health Care Card rate). Concessional safety net applies of (2015) $366.

Example

A person who has high blood pressure and type two diabetes.

	No Medicare	Medicare
No SRSS provider	Metformin 500mg, 100 tablets $16.09 x 100 tablets Perindopril arginine 10 mg tablet, 30 tablets $21.89	Metformin 500mg, 100 tablets $16.09 Perindopril arginine 10 mg tablet, 30 tablets $21.89
SRSS provider	Metformin 500mg, 100 tablets $6.10 x 100 tablets Perindopril arginine 10 mg tablet, 30 tablets $6.10	Metformin 500mg, 100 tablets $6.10 x 100 tablets Perindopril arginine 10 mg tablet, 30 tablets $6.10

People in community detention will receive health care and pharmaceuticals though IHMS contracted services, more information here.

Recommendations to prescribers

• Choose generic and cheaper brand medications if available.
• Write all pharmaceuticals required by a client on a script, even those available over the counter.
• Spend time checking and developing the patient’s health literacy
  • Explain the medication regime to the patient and check understanding. This online pictorial tool may assist: easidose.com
  • Explain repeat scripts to patients; there is anecdotal evidence that many clients come back for another script for their medication simply because they do not understand they can get repeats from their original scripts.
  • Explain to the patient NOT to share or give their medications to any other person.

Recommendation to health service administrators and other asylum seeker advocates

• Work with SRSS providers to develop service delivery arrangements with pharmacists that are accessible to people seeking asylum. i.e near commonly accessed general practices or community health centres.
• Support clients to be aware of pharmacies that have service arrangements with their SRSS provider.

Some advice from Dr Christine Phillips (2014)

“Ability to afford medications – Asylum seekers with chronic diseases are often faced with choosing between medications (Case 1). GPs should assist them in decision-making about which medication to prioritise and, where possible, should prescribe the cheapest medication in its class or for the therapeutic purpose.

Case 1
Irfan was an asylum seeker from Iran, aged 28 years. He was granted a bridging visa, which gave him access to Medicare, but no healthcare card. Irfan had diabetes and had a myocardial infarction shortly after leaving immigration detention. His prescribed medications were metformin, metoprolol, rosuvastatin and low-dose aspirin, but he could only afford to purchase metformin. On review 12 months later, he had diabetic retinopathy, hypertension and an HbA1c of 8.2%. Irfan needed to switch to insulin, more involved monitoring and an ACE inhibitor in addition to rosuvastatin and metoprolol. To ensure he could afford the medications, the practice nurse costed the cheapest medications from a discount pharmacy, and the GP sought support from a local church organisation and diabetes educator to help pay for some of the medications and monitoring equipment.”

Reference: Phillips, C (2014) ‘Beyond resettlement: long-term care for people who have had refugee-like experiences’,  Australian Family Physician 43(11) p764-767.